Related Experiment Video
Updated: Mar 31, 2026
In Vitro Microfluidic Disease Model to Study Whole Blood-Endothelial Interactions and Blood Clot Dynamics in Real-Time
Published on: May 24, 2020
Implementation of Out-of-Office Blood Pressure Monitoring in the Netherlands: From Clinical Guidelines to Patients'
Pricivel M Carrera1, Mattijs S Lambooij
1From the National Institute for Public Health and the Environment (RIVM), Department Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands.
Insights
Physicians in the Netherlands prefer 24-hour ambulatory blood pressure measurement (ABPM) over home BP measurement (HBPM), hindering HBPM adoption despite patient challenges with ABPM. Physician attitudes significantly influence patient acceptance and use of out-of-office BP monitoring.
Area of Science:
- Cardiology
- Health Services Research
- Medical Informatics
Background:
- Clinical guidelines promote out-of-office blood pressure monitoring (OOBPM) for hypertension management and patient engagement.
- Dutch cardiovascular risk management (CVRM) guidelines lack explicit recommendations for 24-hour ambulatory blood pressure measurement (ABPM) and home BP measurement (HBPM).
- Understanding patient and physician perspectives on OOBPM is crucial for effective implementation in the Netherlands.
Purpose of the Study:
- To explore patient and physician acceptance and use of OOBPM in the Netherlands.
- To identify real-world challenges limiting the implementation of ABPM and HBPM.
- To understand the influence of CVRM recommendations on OOBPM practices.
Main Methods:
- Descriptive study utilizing focus group discussions (FGDs) with patients and physicians.
- Development of an analytical framework based on the Technology Acceptance Model (TAM), theory of planned behavior, and model of personal computing utilization.
- Analysis of FGD transcriptions to explore acceptance and usage mechanisms.
Main Results:
- Physicians primarily prescribed and patients used ABPM, despite patient feedback on poor tolerance.
- HBPM was not offered to patients, with limited awareness despite some patients owning home devices.
- Physicians' preference for ABPM, driven by positive attitudes and perceived patient self-efficacy, impeded HBPM adoption, while patient acceptance of HBPM depended on physician adoption.
Conclusions:
- Physician attitudes and practices are pivotal in the adoption and diffusion of OOBPM methods like ABPM and HBPM.
- The current OOBPM landscape in the Netherlands is physician-driven, potentially limiting patient-centered care and the uptake of alternative methods like HBPM.
- Interventions aimed at increasing OOBPM adoption should address physician perspectives and encourage broader acceptance of methods like HBPM.
Abstract:
Out-of-office blood pressure monitoring is promoted by various clinical guidelines toward properly diagnosing and effectively managing hypertension and engaging the patient in their care process. In the Netherlands, however, the Dutch cardiovascular risk management (CVRM) guidelines do not explicitly prescribe 24-hour ambulatory blood pressure measurement (ABPM) and home BP measurement (HBPM). The aim of this descriptive study was to develop an understanding of patients' and physicians' acceptance and use of out-of-office BP monitoring in the Netherlands given the CVRM recommendations.Three small focus group discussions (FGDs) with patients and 1 FGD with physicians were conducted to explore the mechanisms behind the acceptance and use of out-of-office BP monitoring and reveal real-world challenges that limit the implementation of out-of-office BP monitoring methods. To facilitate the FGDs, an analytical framework based on the technology acceptance model (TAM), the theory of planned behavior and the model of personal computing utilization was developed to guide the FGDs and analysis of the transcriptions of each FGD.ABPM was the out-of-office BP monitoring method prescribed by physicians and used by patients. HBPM was not offered to patients even with patients' feedback of poor tolerance of ABPM. Even as there was little awareness about HBPM among patients, there were a few patients who owned and used sphygmomanometers. Patients professed and seemed to exhibit self-efficacy, whereas physicians had reservations about (all of their) patients' self-efficacy in properly using ABPM. Since negative experience with ABPM impacted patients' acceptance of ABPM, the interaction of factors that determined acceptance and use was found to be dynamic among patients but not for physicians.In reference to the CVRM guidelines, physicians implemented out-of-office BP monitoring but showed a strong preference for ABPM even where there is poor tolerance of the method. We found that physicians' positive attitude to ABPM enabled the use of the method by patients which, in turn, impeded the diffusion of HBPM. For patients, the acceptance process of HBPM can only begin after the physician has adopted the innovation. Physicians are in a position to encourage as well as hinder out-of-office BP monitoring and self-management.
Related Concept Videos
01:25Errors occurring during blood pressure monitoring
Several factors...
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:30Equipments Used To Measure Blood Pressure
This invasive approach involves cannulating a peripheral artery. During each cardiac contraction, pressure generates mechanical motion within the catheter, transmitted through rigid, fluid-filled tubing to a transducer. This transducer converts mechanical motion into electrical signals displayed as waveforms on a monitor. An automatic flushing system prevents blood backflow. Due to the potential risk of unexpected arterial blood loss, this method is primarily used in intensive...
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:21Sites for measuring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:23Assessment of blood pressure in brachial artery(two-step method)