Family medicine residents' and attendings' perceived barriers to home blood pressure monitoring

Research Statement
We piloted an initiative for residents and attendings to prescribe or hand out free home blood pressure monitors to patients with hypertension in our residency clinic and evaluated the barriers encountered.

Background and relevance of the study
In the US, hypertension (HTN) affects 47% of adults and contributes to 670,000 deaths yearly. Due to Covid, telehealth has become widely adopted and patients’ ability to monitor home blood pressures (BP) is critical.

Design and Methods
Starting in April 2021, the University of Hawaii Department of Family Medicine and Community Health clinic encouraged clinicians to prescribe or give free home BP monitors to patients with hypertension. In May 2022, clinicians completed an anonymous survey about barriers to home BP monitoring.

Results
A total of 26 clinicians (20 residents, 6 attendings) participated (response rate 79%). Most respondents reported that home BP monitoring improved patients’ BP (69%), medication adherence (58%), and engagement (69%). The major barriers to home BP monitoring were: insurance did not cover BP monitor (81%), BP monitor cost (73%), difficulty prescribing monitor (69%), patient not interested (50%), and BP monitor hard to use (31%). Many (63%) reported difficulty getting BP monitors covered by insurance.

Conclusions
Our clinicians felt that home BP monitoring improved patients’ treatment and control of HTN. However important barriers remain including difficulty with insurance coverage, cost, and prescribing of BP monitors along with lack of patient interest even when free BP monitors are available.

Significance
Identifying barriers to home blood pressure monitoring could help other programs or institutions anticipate and pre-emptively address such difficulties and thus have better success with providing blood pressure monitors to their patients with hypertension.