Graphic desing: Mireille Courteau

Background Literature Objectives Methods

ResultsDiscussion

Recommendations

Conclusion

References

43

57

52

48

30

48

91

9

91

54

46

23

77

23

69

62

38

69

42

58

58

42

21

71

75

25

63

Gender

Men

Women

Age

< 40 years old*

> 41 years old*

Education

Collegial**

University**

Employment

Full time**

Partial time**

Has a family doctor **

Sociodemographic characteristicsSociodemographic characteristics

Individual(n=23)

(%)

Group(n=13)

(%)

Self-learning(n=24)

(%)

* Difference between three groups, p = 0,004 ** Difference between three groups, p <0,0001

i Hypertension (HTN) is one of the most important risk factor of cardiovascular disease.1

i 19% of Canadian adults have HTN.2

i Three different methods can be used to measure blood pressure:

l Office blood pressure measurement

l Ambulatory blood pressure monitoring (ABPM)

l Home blood pressure measurement (HBPM)

i HBPM is popular among hypertensive patients.3

i Learning and using a validated protocol for HBPM is essential to get valid measurements.4

i Hypertension (HTN) is one of the most important risk factor of cardiovascular disease.1

i 19% of Canadian adults have HTN.2

i Three different methods can be used to measure blood pressure:

l Office blood pressure measurement

l Ambulatory blood pressure monitoring (ABPM)

l Home blood pressure measurement (HBPM)

i HBPM is popular among hypertensive patients.3

i Learning and using a validated protocol for HBPM is essential to get valid measurements.4

i HBPM is useful to predict cardiovascular risk.5

i HBPM eases detection of white coat HTN6 and masqued HTN.7

i HBPM improves therapeutic observance8 and blood pressure control.9

i Educative programs: two studies.iArmstrong et al. (1995)- Design: pre-experimental post-test only- N= 30- Individual HBPM educative program lasting 45 minutes - Auscultatory technique- Good results in knowledge and practice evaluation

iStryker et al. (2004)- Design: pre-experimental pre-test post-test - N= 80- Individual HBPM educative program lasting 10 minutes - Oscillometric technique- Improvement in practice

i Framework: CHEP (Canadian Hypertension Education Program ) was used for knowledge and practice evaluation.4

i HBPM is useful to predict cardiovascular risk.5

i HBPM eases detection of white coat HTN6 and masqued HTN.7

i HBPM improves therapeutic observance8 and blood pressure control.9

i Educative programs: two studies.iArmstrong et al. (1995)- Design: pre-experimental post-test only- N= 30- Individual HBPM educative program lasting 45 minutes - Auscultatory technique- Good results in knowledge and practice evaluation

iStryker et al. (2004)- Design: pre-experimental pre-test post-test - N= 80- Individual HBPM educative program lasting 10 minutes - Oscillometric technique- Improvement in practice

i Framework: CHEP (Canadian Hypertension Education Program ) was used for knowledge and practice evaluation.4

1 - KnowledgeEvaluation in adults of the impact of three HBP educative program : individual training, group training and self-learning on knowledge.

2 - PracticeEvaluation in adults of the impact of three HBP educative program : individual training, group training and self-learning on practice.

1 - KnowledgeEvaluation in adults of the impact of three HBP educative program : individual training, group training and self-learning on knowledge.

2 - PracticeEvaluation in adults of the impact of three HBP educative program : individual training, group training and self-learning on practice.

i Pre-test post-test with 3 random groups.

i Pre-test: knowledge evaluation with question-naire (12 questions).

i Post-test: practice evaluation with observation grid (8 observations) and knowledge evaluation of with same questionnaire than pre-test.

i Convenient sampling among university adult workers.

i Pre-test post-test with 3 random groups.

i Pre-test: knowledge evaluation with question-naire (12 questions).

i Post-test: practice evaluation with observation grid (8 observations) and knowledge evaluation of with same questionnaire than pre-test.

i Convenient sampling among university adult workers.

UQTR ethic certificate no CER–09-147-07.07

Knowledge

i For knowledge, scores achieved in post-test for individual training, group training and self-learning are = 90% (97%, 99% and 90% respectively).

i Scores achieved in post-test evaluation are better than scores obtained in pre-test (38%, 54% and 45% respectively; p < 0,000).

i Scores reached with self-learning educative program are below the average of individual and group training scores (p = 0,01).

i The least successful answers are related to threshold value and rest period needed before measurement.

Practice

i For practice, scores achieved in post-test for individual training, group training and self-learning are 74%, 79% and 53% respectively.

i Scores reached with self-learning educative program are inferior to individual and group training results (p= 0,01).

i The least successful observations are related to back position, rest period, talking during measurement and second measurement. Rest period is also an observation with poor scores in another study about HBPM.11

Strenghts

i It’s the first study realised in Quebec about HBP educative programs with knowledge and practice evaluation of adult workers.

i A HBPM educative program can be realised in 10 minutes with knowledge improvement in short delays.

Limits

i Results cannot be generalised to general population because of the small sample and the inequal sociodemographic characteristics between groups.

i Low scores obtained in practice evaluation can be a consequence of laboratory condition.

Knowledge

i For knowledge, scores achieved in post-test for individual training, group training and self-learning are = 90% (97%, 99% and 90% respectively).

i Scores achieved in post-test evaluation are better than scores obtained in pre-test (38%, 54% and 45% respectively; p < 0,000).

i Scores reached with self-learning educative program are below the average of individual and group training scores (p = 0,01).

i The least successful answers are related to threshold value and rest period needed before measurement.

Practice

i For practice, scores achieved in post-test for individual training, group training and self-learning are 74%, 79% and 53% respectively.

i Scores reached with self-learning educative program are inferior to individual and group training results (p= 0,01).

i The least successful observations are related to back position, rest period, talking during measurement and second measurement. Rest period is also an observation with poor scores in another study about HBPM.11

Strenghts

i It’s the first study realised in Quebec about HBP educative programs with knowledge and practice evaluation of adult workers.

i A HBPM educative program can be realised in 10 minutes with knowledge improvement in short delays.

Limits

i Results cannot be generalised to general population because of the small sample and the inequal sociodemographic characteristics between groups.

i Low scores obtained in practice evaluation can be a consequence of laboratory condition.

Practice

i HBP educative program can be achieved in less than 15 minutes by a nurse and can improve knowledge and practice immediatly after attainment.

i Written documentation alone is not sufficient for knowledge acquisition. Interaction between patients and health professionals that can make demonstrations and answer questions is more efficient.

Research

i Repeat evaluations in 3 months to verify educative program effect on knowledge and practice retention.

i Pursue experimentation with educative programs on specific populations (exclusively HTN, different levels of education, etc.).

Practice

i HBP educative program can be achieved in less than 15 minutes by a nurse and can improve knowledge and practice immediatly after attainment.

i Written documentation alone is not sufficient for knowledge acquisition. Interaction between patients and health professionals that can make demonstrations and answer questions is more efficient.

Research

i Repeat evaluations in 3 months to verify educative program effect on knowledge and practice retention.

i Pursue experimentation with educative programs on specific populations (exclusively HTN, different levels of education, etc.).

i All HBP educative programs used in this study increase knowledge and practice.

i Individual and group training are more efficient than self-learning educative program, especially for practice.

i All HBP educative programs used in this study increase knowledge and practice.

i Individual and group training are more efficient than self-learning educative program, especially for practice.

Université du Québec à Trois-Rivières

available population : 1349

Sample:95 subjects

Withdrawal of 18 subjects

Withdrawal of 8 subjects

Randommization

Self-learning:32 subjects

Individual training:

32 subjects

Group training:

31 subjects

Self-learning:n=24

Individual training:n=23

Group training:n=13

Withdrawal of 9 subjects

1 - Knowledge1 - Knowledge

2 - Practice2 - Practice

** Score difference between three groups, p < 0,0001

* p < 0,0001

Knowledge scores (%)Knowledge scores (%)

0

20

40

60

80

100

pre-test

post-test**

Self-learning* n=24

Group* n=13

Individual* n=23

p= 0,01

p= 0,274 p= 0,01

97 99

90

38

54

45

knowledge (%)

Educative programs

* Score difference between three groups, p <0,0001

post-test*

Practice scores (post-test only) (%)Practice scores (post-test only) (%)

Self-learning n=24

Group n=13

Individual n=23

0

10

20

30

40

50

60

70

80

p= 0,01

p= 0,397 p= 0,01

74

79

53

practice (%)

Educative programs

1. Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F., and al. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancand, 364 (9438), 937-952.

2. Wilkins, K., Campbell, N. R. C., Joffres, M. R., McAlister, F. A., Nichol, M., Quach, S., et al. (2010). Tension artérielle des adultes au Canada. Statistique Canada, No 82-003-X au catalogue, Rapports sur la santé, 21 (1).

3. Lopez, L. M., & Taylor, J. R. (2004). Home blood pressure monitoring: point-of-care testing. The Annals Of Pharmacotherapy, 38 (5), 868-873.

4. Padwal, R. S., Hemmelgarn, B. R., Khan, N. A., Grover, S., McKay, D. W., Wilson, T., and al. (2009). The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1--blood pressure measurement, diagnosis and assessment of risk. The Canadian Journal Of Cardiology, 25 (5), 279-286.

5. Bobrie, G., Chatellier, G., Genes, N., Clerson, P., Vaur, L., Vaisse, B., and al. (2004). Cardiovascular Prognosis of "Masked Hypertension" dandected by blood pressure self-measurement in elderly treated hypertensive patients. Journal of American Medical Association, 291(11), 1342-1349.

6. Stergiou, G. S., Skeva, II, Baibas, N. M., Kalkana, C. B., Roussias, L.

G., & Mountokalakis, T. D. (2000). Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements. Journal Of Hypertension, 18 (12), 1745-1751.

7. Terawaki, H., Mandoki, H., Nakayama, M., Ohkubo, T., Kikuya, M., Asayama, K., and al. (2008). Masked hypertension dandermined by self-measured blood pressure at home and chronic kidney disease in the Japanese general population: the Ohasama study. Hypertension Research: Official Journal Of The Japanese Sociandy Of Hypertension, 31 (12), 2129-2135 .

8. Ogedegbe, G., & Schoenthaler, A. (2006). A systematic review of the effects of home blood pressure monitoring on medication adherence.

The Journal of Clinical Hypertension, 8, 174-180.

9. Cappuccio, F. P., Kerry, S. M., Forbes, L., & Donald, A. (2004). Blood pressure control by home monitoring: manda-analysis of randomised trials. BMJ (Clinical Research Ed.), 329 (7458), 145-148

10. Armstrong, R., Barrack, D., & Gordon, R.(1995). Patients achieve accurate home blood pressure measurement following instruction. Australian Journal of Advanced Nursing, 12(4), 15-21.

11. Stryker, T., Wilson, M., & Wilson, T. W. (2004). Accuracy of home blood pressure readings: monitors and operators. Blood Pressure Monitoring, 9 (3), 143-147.

Proportion of good answers (pre-test post-test)Proportion of good answers (pre-test post-test)

100

100

91

100

96

100

96

96

100

100

100

87

52 4

35 4

39 4

91 4

61 4

26 4

17 4

13 4

17 4

13 4

83 4

9 4

100

100

100

100

100

100

100

100

100

100

100

92

62 4

46 4

46 4

92 4

69 4

54 4

46 4

23 4

38 4

31 4

100 4

38 4

92

100

79

100

88

92

88

92

88

88

96

75

38 4

63 4

42 4

88 4

46 4

42 4

38 4

21 4

38 4

21 4

92 4

13 4

Cuff size

Impact of meal

Rest period

Body position

Arm position

Difference of pressure between arms

Need to use washroom before measurement

Number of measurement

Time of the day for measurement

Number of days for measurement

Recording

Threshold value at home

Question Individual(n=23)

group(n=13)

Self-learning(n=24)

pré-test 4 post-test ( %)

Proportion of good observations (post-test only)Proportion of good observations (post-test only)

39

96

74

96

50

78

74

91

46

100

92

92

92

85

62

92

33

88

38

83

13

63

39

71

Rest period

Arm preparation

Talking during measurement

Avoid moving during measurement

Back supported

Feet on the floor

Second measurement

Arm support at heart level

Observation Individual(n=23)

Group(n=13)

Self-learning(n=24)

post-test only ( %)

HOME BLOOD PRESSURE EDUCATIVE PROGRAMS : impact on adult knowledge and practice

Marie-Ève Leblanc RN BN�Lyne Cloutier RN PhD

Department of Nursing, �Université du Québec à Trois-Rivières

AcknowledgementsHome blood pressure automatic machines

used in project (3AG1 model) come from