Questioning the status quo

It all started with one simple question: Is this absolutely necessary? Up until then, best practice had dictated that measuring blood pressure (BP) in medical offices should be done in exam rooms only.

Dr. Michelle Greiver
Dr. Michelle Greiver, a Family Physician in the Department of Family and Community Medicine at NYGH

“I was curious and wanted to know why this was advisable,” says Dr. Michelle Greiver, a Family Physician in the Department of Family and Community Medicine at North York General Hospital. “I've learned that if something doesn't make sense to you, you need to ask questions. And if the answer doesn't satisfy you, then it's your responsibility to keep pressing until you find an answer that does.”

While seemingly insignificant at first, Dr. Greiver knew that every step in patient care has a ripple effect. Confining BP measurement to exam rooms didn't seem efficient or necessary. Surely, greater flexibility to provide the right care, at the right time, in the right place mattered. Unable to find an answer to her question, Dr. Greiver applied for a North York General research award to support her investigation. 

After testing BP measurements using an automated office BP machine in different areas, Dr. Greiver unearthed the truth: location wasn't everything. “The measurements did not appear to be significantly altered by the setting in which BP is measured,” she says. “Measurements taken in a physician's examination room or in more open areas of an office have been shown to be similar.”

Dr. Greiver's findings were then incorporated into the Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. In addition to greater care delivery flexibility, the revised guidelines could enable better patient care and flow by providing more places where BP can be done.

a person getting their blood pressure taken

“In some settings, BP is measured with a manual cuff, which — although effective and more portable — does have room for some variances in interpretation,” says Dr. Michelle Greiver.

“For instance, in some settings, BP is measured with a manual cuff, which — although effective and more portable — does have room for some variances in interpretation,” says Dr. Greiver. “Half of all measurements that are taken manually end in zero. This is based on a very human tendency to round up or down. An automated blood pressure machine doesn't have a bias in recording and is often more accurate.” 

“Now, if you have an office area for blood pressure measurement through an automated machine, this may help provide more accurate diagnoses,” she says. “Either way, we have greater flexibility to explore alternatives. Seemingly small changes can lead to enhanced patient- and family-centred care.” 

 

This article first appeared in the July-August 2017 issue of The Pulse.

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