title: Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England.
abstract: BACKGROUND
  Previous surveys identified a shift to nurse-led care in hypertension in 2010. In 2011 the National Institute for Health and Care Excellence (NICE) recommended ambulatory (ABPM) or home (HBPM) blood pressure (BP) monitoring for diagnosis of hypertension.
  
  
  OBJECTIVE
  To survey the organisation of hypertension care in 2016 to identify changes, and to assess uptake of NICE diagnostic guidelines.
  
  
  METHODS
  Questionnaires were distributed to all 305 general practices in South West England.
  
  
  METHODS
  Responses were compared with previous rounds (2007 and 2010). Data from the 2015 Quality and Outcomes Framework (QOF) were used to compare responders with non-responders, and to explore associations of care organisation with QOF achievement.
  
  
  RESULTS
  One-hundred-and-seventeen practices (38%) responded. Responders had larger list sizes and greater achievement of the QOF target BP ≤150/90 mmHg. Healthcare assistants (HCAs) now monitor BP in 70% of practices, compared with 37% in 2010 and 19% in 2007 (P<0.001). Nurse prescribers alter BP medication in 26% of practices (11% in 2010, none in 2007;P<0.001). Of the practices, 89% have access to ABPM, but only 71% report confidence in interpreting results. Also, 87% offer HBPM, with 93% of these confident in interpreting results.
  
  
  CONCLUSIONS
  In primary care BP monitoring has devolved from GPs and nurses to HCAs. One in 10 practices are not implementing NICE guidelines on ABPM and HBPM for diagnosis of hypertension. Most practices express confidence interpreting HBPM results but less so with ABPM. The need for education and quality assurance for allied health professionals is highlighted, and for training in ABPM interpretation for GPs.
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, Devon.
authors.forename: Natasha
authors.initials: N
authors.lastname: Mejzner
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, Devon.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Clark
authors.affiliation: East Somerset Research Consortium, Westlake Surgery, Yeovil, Somerset.
authors.forename: Lindsay Fp
authors.initials: LF
authors.lastname: Smith
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, Devon.
authors.forename: John L
authors.initials: JL
authors.lastname: Campbell
mesh_terms: D000488:Allied Health Personnel / Q000458:organization & administration / Q000639:trends; D000704:Analysis of Variance; D001795:Blood Pressure Determination / Q000379:methods / Q000451:nursing / Q000639:trends; D003157:Community Pharmacy Services / Q000458:organization & administration / Q000639:trends; D004739:England; D058006:General Practice / Q000458:organization & administration / Q000639:trends*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000451:nursing*; D009722:Nurse Practitioners / Q000458:organization & administration / Q000639:trends; D017063:Outcome Assessment, Health Care; D010595:Pharmacists / Q000458:organization & administration / Q000639:trends; D057184:Practice Patterns, Nurses' / Q000458:organization & administration / Q000639:trends; D012423:Rural Health; D014504:Urban Health
keywords: blood pressure determination; hypertension; inter-arm difference; primary care