Pediatrician Adherence to Guidelines for Diagnosis and Management of High Blood Pressure

Authors

Corinna J. Rea, Division of General Pediatrics, Boston Children's Hospital, Boston, MA; Harvard Medical School.
Tammy M. Brady, Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.
David G. Bundy, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Moonseong Heo, Department of Public Health Sciences, Clemson University, Clemson, SC.
Elissa Faro, Division of General Internal Medicine, University of Iowa, Iowa City, IA.
Kimberly Giuliano, Department of Primary Care Pediatrics, Cleveland Clinic, Cleveland, OH.
Beatrice Goilav, Division of Pediatric Nephrology, The Children's Hospital at Montefiore, Bronx, NY; Albert Einstein College of Medicine, Bronx, NY.
Peterkaye Kelly, Division of Pediatric Nephrology, The Children's Hospital at Montefiore, Bronx, NY; Division of General Academic Pediatrics, The Children's Hospital at Montefiore, Bronx, NY.
Kelly Orringer, Division of General Pediatrics, Michigan Medicine, Ann Arbor, MI.
Beth A. Tarini, Center for Translational Research, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University.
Katherine Twombley, Pediatric Nephrology, Medical University of South Carolina, Charleston, SC.
Michael L. Rinke, Division of Pediatric Nephrology, The Children's Hospital at Montefiore, Bronx, NY; Division of General Academic Pediatrics, The Children's Hospital at Montefiore, Bronx, NY.

Document Type

Journal Article

Publication Date

3-1-2022

Journal

The Journal of pediatrics

Volume

242

DOI

10.1016/j.jpeds.2021.11.008

Abstract

OBJECTIVES: To assess pediatrician adherence to the 2017 American Academy of Pediatrics' clinical practice guideline for high blood pressure (BP). STUDY DESIGN: Pediatric primary care practices (n = 59) participating in a quality improvement collaborative submitted data for patients with high BP measured between November 2018 and January 2019. Baseline data included patient demographics, BP, body mass index (BMI), and actions taken. Logistic regression was used to test associations between patient BP level and BMI with provider adherence to guidelines (BP measurement, counseling, follow-up, evaluation). RESULTS: A total of 2677 patient charts were entered for analysis. Only 2% of patients had all BP measurement steps completed correctly, with fewer undergoing 3-limb and ambulatory BP measurement. Overall, 46% of patients received appropriate weight, nutrition, and lifestyle counseling. Follow-up for high BP was recommended or scheduled in 10% of encounters, and scheduled at the appropriate interval in 5%. For patients presenting with their third high BP measurement, 10% had an appropriate diagnosis documented, 2% had appropriate screening laboratory tests conducted, and none had a renal ultrasound performed. BMI was independently associated with increased odds of counseling, but higher BP was associated with lower odds of counseling. Higher BP was independently associated with an increased likelihood of documentation of hypertension. CONCLUSIONS: In this multisite study, adherence to the 2017 American Academy of Pediatrics' guideline for high BP was low. Given the long-term health implications of high BP in childhood, it is important to improve primary care provider recognition and management. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03783650.

APA Citation

Rea, Corinna J.; Brady, Tammy M.; Bundy, David G.; Heo, Moonseong; Faro, Elissa; Giuliano, Kimberly; Goilav, Beatrice; Kelly, Peterkaye; Orringer, Kelly; Tarini, Beth A.; Twombley, Katherine; and Rinke, Michael L., "Pediatrician Adherence to Guidelines for Diagnosis and Management of High Blood Pressure" (2022). GW Authored Works. Paper 683.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/683

Department

Pediatrics