Dataset Information

Quality in screening and measuring blood pressure in China's primary health care: a national cross-sectional study using unannounced standardized patients.

ABSTRACT:

Background

This study aims to evaluate primary care providers' adherence to the standard of measuring blood pressure for people aged 35 or above during their initial visit, as per Chinese guidelines, and to identify factors affecting their practices.

Methods

We developed 11 standardized patients (SP) cases as tracer conditions to evaluate primary care, and deployed trained SPs for unannounced visits to randomly selected providers in seven provinces of China. The SPs used a checklist based on guidelines to record whether and how blood pressure was measured. Data were analyzed descriptively and regression analysis was performed to examine the association between outcomes and factors such as provider, patient, facility, and clinical case characteristics.

Findings

The SPs conducted 1201 visits and found that less than one-third of USPs ≥35 had their blood pressure measured. Only 26.9% of migraine and 15.4% of diabetes cases received blood pressure measurements. Additionally, these measurements did not follow the proper guidelines and recommended steps. On average, 55.6% of the steps were followed with few providers considering influencing factors before measurement and only 6.0% of patients received both-arm measurements. The use of wrist sphygmomanometers was associated with poor blood pressure measurement.

Interpretation

In China, primary care hypertension screening practices fall short of guidelines, with infrequent initiation of blood pressure measurements and inadequate adherence to proper measurement steps. To address this, priority should be placed on adopting, implementing, and upholding guidelines for hypertension screening and measurement.

Funding

National Natural Science Foundation of China, Swiss Agency for Development and Cooperation, Doctoral Fund Project of Inner Mongolia Medical University, China Postdoctoral Science Foundation.

SUBMITTER: Zhang L

PROVIDER: S-EPMC10701131 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Quality in screening and measuring blood pressure in China's primary health care: a national cross-sectional study using unannounced standardized patients.

Zhang Lanping L Liang Huijuan H Luo Huanyuan H He Wenjun W Cai Yiyuan Y Liu Siyuan S Fan Yancun Y Huang Wenxiu W Zhao Qing Q Zhong Dongmei D Li Jiaqi J Lv Sensen S Li Chunping C Xie Yunyun Y Zhang Nan N Xu Dong Roman DR

The Lancet regional health. Western Pacific 20231123

<h4>Background</h4>This study aims to evaluate primary care providers' adherence to the standard of measuring blood pressure for people aged 35 or above during their initial visit, as per Chinese guidelines, and to identify factors affecting their practices.<h4>Methods</h4>We developed 11 standardized patients (SP) cases as tracer conditions to evaluate primary care, and deployed trained SPs for unannounced visits to randomly selected providers in seven provinces of China. The SPs used a checkli ...[more]

PMID: 38076324

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Project description:BackgroundThe unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC.ObjectiveThis study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement.MethodsEleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement.ResultsOnly 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, -0.03 (95% CI -0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place.ConclusionsThere was low agreement between VPs and USPs in PHC quality assessment. This may reflect the "know-do" gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study.

Project description:Background: Pakistan is classified as a high-burden country for tuberculosis, and the prescription of antibiotics and fluoroquinolones complicates the detection and treatment of the disease. The existing literature primarily relies on knowledge questionnaires and prescription analyses, which focus on healthcare providers' knowledge rather than their actual clinical practices. Therefore, this study aimed to evaluate the quality of tuberculosis care using standardized patients. Materials and Methods: We conducted a cross-sectional study, recruiting consenting private healthcare practitioners in four cities in Punjab, Pakistan. Standardized patients were engaged from the general public to simulate four cases: two suspected tuberculosis cases (Case 1 and 2), one confirmed tuberculosis case (Case 3), and one suspected multidrug-resistant tuberculosis case (Case 4). The optimal management in Cases 1 and 2 was referral for sputum testing, chest X-ray, or referral to a public facility for directly observed treatment short-courses without dispensing antibiotics, fluoroquinolones, and steroids. In Case 3, treatment with four anti-TB medications was expected, while Case 4 should have prompted a drug-susceptibility test. Descriptive statistics using SPSS version 23 were employed to analyze disparities in referrals, ideal case management, antibiotic use, steroid administration, and the number of medications prescribed. Results: From July 2022 to May 2023, 3321 standardized cases were presented to private healthcare practitioners. Overall, 39.4% of tuberculosis cases were managed optimally, with Case 3 showing the highest rate (56.7%) and Case 4 showing the lowest (19.8%). City-specific analysis revealed that Rawalpindi had the highest management rate (55.8%), while Sialkot had the lowest (30.6%). Antibiotics were most frequently prescribed in Case 1 and least prescribed in Case 4, with a similar pattern for fluoroquinolones. Anti-TB medications were also prescribed in naïve and suspected tuberculosis cases (8.3% in Case 1 and 10.8% in Case 2). Conclusions: The quality of tuberculosis management in actual practice is suboptimal among healthcare providers in Pakistan. Furthermore, the over-prescription of antibiotics, fluoroquinolones, and anti-TB drugs presents a significant risk for the development of drug-resistant tuberculosis.

Dataset Information

Quality in screening and measuring blood pressure in China's primary health care: a national cross-sectional study using unannounced standardized patients.

Background

Methods

Findings

Interpretation

Funding

Publications

Quality in screening and measuring blood pressure in China's primary health care: a national cross-sectional study using unannounced standardized patients.

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