Barriers and Facilitators to Evidence-based Blood Pressure Control in Community Practice

Abstract

Introduction The Electronic Communications and Home Blood Pressure Monitoring trial (e-BP) demonstrated that team care incorporating a pharmacist to manage hypertension using secure E-mail with patients resulted in almost twice the rate of blood pressure (BP) control compared with usual care. To translate e-BP into community practices, we sought to identify contextual barriers and facilitators to implementation. Methods Interviews were conducted with medical providers, staff, pharmacists, and patients associated with community-based primary care clinics whose physician leaders had expressed interest in implementing e-BP. Transcripts were analyzed using qualitative template analysis, incorporating codes derived from the Consolidated Framework for Implementation Research (CFIR). Results Barriers included incorporating an unfamiliar pharmacist into the health care team, lack of information technology resources, and provider resistance to using a single BP management protocol. Facilitators included the intervention’s perceived potential to improve quality of care, empower patients, and save staff time. Sustainability of the intervention emerged as an overarching theme. Conclusion A qualitative approach to planning for translation is recommended to gain an understanding of contexts and to collaborate to adapt interventions through iterative, bidirectional information gathering. Interviewees affirmed that web pharmacist care offers small primary care practices a means to expand their workforce and provide patient-centered care. Reproducing e-BP in these practices will be challenging, but our interviewees expressed eagerness to try and were optimistic that a tailored intervention could succeed.

Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States

“…22–26 In a recent survey of providers in the Pacific Northwest, the most important barriers to HBPM as part of hypertension self-management related to affordability of devices, accuracy of BP readings, and technical skill requirements, particularly in older patients. 27 A survey of providers in Canada about HBPM identified concerns about the validity of HBPM data and concerns that HBPM would lead patients to become overly preoccupied with BP. 23 While concerns about patient anxiety surrounding HBPM testing emerged as a barrier in the current survey, it received only a moderate number of votes, perhaps because these were less important in the context of one-time diagnostic testing.…”

Implementation Science to Advance Care Delivery: A Primer for Pharmacists and Other Health Professionals

“…CFIR has been widely used in health services research, and most recently in pharmacy practice. Use of this framework has facilitated understanding of the implementation success/failures related to interventions, such as medication synchronization, immunizations, point‐of‐care testing, and hypertension management in community pharmacy settings …”

Identifying Barriers and Facilitators of 13 mHealth Projects in North America and Africa: Protocol for a 5-Year Implementation Science Study (Preprint)

“…This framework can therefore be adapted and used to guide the design of mHealth interventions for particular settings, as well as the study of their implementation. An increasing number of implementation studies have used PROTOCOL 4 | P a g e CFIR, some as an evaluation framework [26][27] [28] , some for detecting factors influencing implementation [29][30], and some for classifying these influencing factors as facilitators or barriers [20] [27]. To date, only a few studies have had the evaluation of CFIR as a specific aim [31][32] [20].…”