Paucity of time prevents doctors from following BP measurement protocol:

M3 India Newsdesk
Dec 05, 2017

Small inaccuracies in blood pressure (BP) measurement can have considerable consequences. We recently conducted an online survey to assess the blood pressure measurement practices among Indian doctors, the most commonly performed clinic examination, yet considerably undervalued.

The survey carried a few simple and direct questions for the Indian doctor community. The doctors were requested to respond voluntarily over a period of 2 weeks. A total of 135 doctors responded to the online questionnaire.
Demographics of the respondents
1 The respondents were split equally between Metro and Non-Metro cities
2 Nearly 50% of respondents were in the age bracket of 30-39 years, and about 30% were between 20-29 years of age
3 A large percentage of respondents (83%) worked in hospitals whereas 23.7% responding doctors owned a private practice

Survey Summary
About 78% of the responding doctors used manual BP measuring apparatus. A very small number of surveyed doctors used automated machines for measuring patient’s blood pressure. A nephrologist (30-39 y) responded, “Manual BP measurement is always preferable to electronic devices, especially in patients with associated renal disease”.
Any specific protocol followed?
When asked if they followed any specific protocol for measuring patients’ BP, 71 % of doctors answered in affirmative but about 29% doctors responded saying that they did not follow any protocol for BP measurement of their patients.

A common response recorded was that the “American Heart Association Guidelines” were followed. However, a few other respondents mentioned that they followed the “JNC 7th classification” protocol. “Intergrowth-21st” protocol was also mentioned by some of the respondents. A common response recorded was the use of both methods” First palpatory then auscultatory” for BP measurement. A young oncologist (30-39 y) responded that the BP measurement protocol followed was “3 hours after BP medication and early morning”. A senior (70+ y) pediatrician responded, “Patient must be mentally and physically calm. Size of cuff must be proper. Avoidance of slightest activities, it can change the reading”.
Few others mentioned the following protocols,
1 Checking BP in both the arms. Sitting and lying position
2 Using accurate cuff size on bare arms
3 3 consecutive readings at different intervals
4 In supine position
Why do doctors not follow BP measurement protocol?
Doctors who did not follow any specific protocol for BP measurement cited various reasons for doing so. A young (30-39y) psychiatrist cited “lack of time” whereas an obstetrician(40-49y) pointed out to” huge patient load”. A young(20-29y) oncologist responded that there were “no protocols” in the organisation where he/she worked.Yet another respondent commented that he/she was "not aware" of any protocol for BP measurement.
The critical factors
When asked if they believed if BP measurement technique affected overall hypertension management, about 98% doctors answered in affirmative. A common response was that it “helps in correct decision making”.

A young pediatrician (30-39 y) responded, “ Accurate BP measurement will be the base for medicine selection for a particular patient”, whereas another senior (60-69 y)obygynae responded, “Dosage of a drug can be altered according to B.P.control”.One of the young(20-29 y) obgynae respondent pointed out, “Incorrect method of BP measurement can overestimate or underestimate the actual value”.
A very small percentage (2.2%) of responding doctors believed that the BP measurement technique did not affect the overall hypertension management of the patient. A young oncologist (20-29 y)believed that “its more or less similar readings”.
Naming the critical factors
When the doctors were asked to choose the factors which they considered critical while BP measurement; “using the correct cuff size” was picked by most (86%)of the surveyed doctors followed by “ 5 minutes rest before measurement” picked by 83% doctors.

70 % of the surveyed respondents also believed that “placing the cuff over bare arm” was a critical factor in obtaining accurate BP measurement. Another critical factor was chosen by a majority (60%) of respondents in obtaining accurate BP measurement was “supporting patients’ arm” and nearly 50% chose “measuring BP on both arms”. Many (46.7%) surveyed doctors also chose “avoiding conversation during the check” to obtain accurate BP readings.
The responding doctors believed that the “critical factors” picked were grave, an oncologist (30-39 y) responded, “Inaccurate measurement of blood pressure can potentially result in misclassification of patients as hypertensive or normotensive as well as lead to inappropriate medical management”.
A young diabetologist(20-29y) responded, “Any change in those critical steps cause increased preload, doesn't allow any hormonal release which contributes to increase in BP like adrenaline”.

We have presented the data and facts as they are without generalizing the results as a reflection of the views of entire Indian doctor population. The demographic profile of the survey participants [shown above] may differ from the population of all Indian Doctors. Also, limiting the sample to the Internet channel only may introduce bias in the results. We also urge that the findings should not be interpreted as implying cause and effect.

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