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Pediatrician Adherence to Guidelines for Diagnosis and Management of High Blood Pressure. OBJECTIVES: To assess pediatrician adherence to the 2017 American Academy of Pediatrics' (AAP) clinical practice guideline for high blood pressure (BP). STUDY DESIGN: Pediatric primary care practices (N= 59) participating in a quality improvement collaborative submitted data for patients with high BP measured between Nov 2018 and Jan -2019. Baseline data included patient demographics, BP, BMI, and actions taken. Logistic regression was used to test associations between patient BP level and BMI with provider adherence to guidelines (BP measurement, counseling, follow-up, evaluation). RESULTS: A total of 2677 patient charts were entered for analysis. Only 2% of patients had all BP measurement steps completed correctly, with fewer undergoing 3-limb and ambulatory BP measurement. Overall, 46% of patients received appropriate weight, nutrition and lifestyle counseling. Follow-up for high BP was recommended or scheduled in 10% of encounters, and scheduled at the appropriate interval in 5%. For patients presenting with their third high BP measurement, 10% had an appropriate diagnosis documented, 2% had appropriate screening laboratory tests conducted, and none had a renal ultrasound performed. BMI was independently associated with increased odds of counseling, but higher BP was associated with lower odds of counseling. Higher BP was independently associated with an increased likelihood of documentation of hypertension. CONCLUSIONS: In this multi-site study, adherence to the 2017 AAP guideline for high BP was low. Given the long-term health implications of high BP in childhood, it is important to improve PCP recognition and management.