Improving the Home Blood Pressure Monitoring Program at an Urban Free Clinic

Background: Many patients with abnormal blood pressures are not accurately assessed in a clinical setting. Home blood pressure monitoring allows patients to regularly check their blood pressure without having to come to a clinic. While this resource is becoming more common, it is often underutilized or used sub-optimally. Many times, patients may take their blood pressures at home incorrectly, not record the values accurately, or fail to report them to their healthcare provider. By improving the accuracy of blood pressure values taken and recorded, providers will be able to assess for hyper/hypotension and provide better treatment. Methods: This project aimed to increase the number of blood pressure logs returned and filled out completely. Educational materials were created to help re-educate staff and be used for the onboarding process of new staff/volunteers. Patients were then educated by clinic staff and providers in order to increase the number of completed blood pressures logs that were averaged and uploaded to the electronic medical record (EMR). The number of averaged blood pressures uploaded to the EMR was measured for three months and compared to the same three months of the previous year. Post-implementation questionnaires were sent to staff and providers to assess usability, feasibility, and satisfaction. Results: Before the intervention, there were 18 patients that received a blood pressure cuff in a three- month period, and five had their blood pressures accurately assessed and electronically documented. After the intervention, 46 patients were supplied with home blood pressure cuffs with 25 that had results uploaded to the EMR. A Fisher Exact Test was used to examine the relationship between staff/provider education and the number of completed blood pressure logs. The results were not statistically significant at p < 0.05, with a Fisher Exact Statistic value of 0.09. However, the results were clinically significant, showing an increase in the percentage of documented blood pressures from 28% to 54%. Conclusions: The educational materials provided to the clinic helped increase the number of patients who had their blood pressures averaged and uploaded to the EMR. While the results were statistically insignificant, this was likely due to a small pre-implementation sample size. More information is needed to see if the improvement in blood pressure documentation practices leads to improvement in the management of hyper/hypotension.