A Study Of Blood Pressure Screening And Measurement Quality In Public And Private Primary Care Providers Using Unannounced Standardized Patients

ObjectThis study used unannounced standardized patients to collect blood pressure screening and measurement quality data of primary care providers to assess primary care providers’ adherence to optimal blood pressure screening and best measurement practices and to analyze influencing factors.Based on this,this study will explore the impact of ownership on quality of care,provide a basis for decision making to improve blood pressure screening awareness and blood pressure measurement practices in primary care,and provide empirical support for the theoretical basis of the relationship between ownership and quality of care.MethodsEleven common primary care cases were selected for the study and purposely selected for unannounced USP-clinician visits in seven provinces representing different economic,cultural,health levels and geographic locations in China(from north to south including Inner Mongolia Autonomous Region,Gansu Province,Shaanxi Province,Hunan Province,Guizhou Province,Sichuan Province and Guangdong Province),where unannounced standardized patients were recruited and trained to collect the data that primary care physicians whether and how blood pressure was measured during the their visit.The study used descriptive analysis to understand the status of blood pressure screening and measurement quality in primary care,and explored the influencing factors using generalized linear models,and then further used a propensity score to control for confounders and isolate the effect of ownership on blood pressure screening and measurement quality.ResultThe study included 1201 visits,and the results showed that less than one-third of standardized patients aged 35 or older had their blood pressure measured.On average,only 57.4%of the steps were followed,and only 6.0%of patients received blood pressure measurement on both arms.We found that adherence was higher among healthcare providers in economically developed provinces or higher-level medical institutions;The use of wrist-type blood pressure monitors was associated with poor blood pressure measurement results;and that female primary health care providers had better quality of blood pressure screening and measurement.When comparing public and private primary healthcare institutions,there was no statistically significant difference in the quality of blood pressure screening and measurement,after further balancing the covariates between the two using propensity score methods,it still cannot be assumed that the form of ownership affects the quality of blood pressure screening and measurement in primary care providers.ConclusionOverall,awareness of blood pressure screening in primary healthcare institutions is weak,and primary healthcare providers may measure blood pressure for diagnostic purposes.The blood pressure measurement standardization among primary healthcare providers is poor.Therefore,it is necessary to improve the first-line blood pressure measurement information platform,strengthen the training and incentives for primary healthcare personnel,provide regular feedback and evaluation of their daily practice,and improve their awareness of blood pressure screening and measurement practices.