Understanding Measurement of Postural Hypotension in Primary Care – A qualitative approach.

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

5B.3

Presenter:

Rosina Cross

Twitter:

@RosinaACross

Co-authors:

Sinéad TJ McDonagh1, James Sheppard2, Gary Abel1, Rupert Payne1, Katrina Turner3, Richard McManus2, John Campbell1, Jane Masoli1, Judit Konya1, Jayne Fordham, Sallie Lamb1, Christopher E Clark1

Author institutions:

1Primary Care Research Group, College of Medicine and Health, University of Exeter 2 Nuffield Department of Primary Care Health Sciences, University of Oxford 3Bristol Medical School, Population Health Sciences, University of Bristol 4Mid Devon Medical Practice

Problem

A drop in blood pressure (BP) when moving from sitting, or lying, to standing is called postural hypotension (PH). PH is associated with future cognitive decline, falls and increased mortality. These problems represent a significant burden to the NHS; their risks can be reduced if PH is identified early, in order to facilitate relevant interventions. PH is often asymptomatic, therefore, a systematic approach to detection is required. However, this does not currently occur in English primary care settings. Our related survey found that 8% of staff do not consider PH when measuring BP; whilst most do check in the presence of symptoms only a minority consider PH for any other guideline recommended indication.

Reasons for limited PH detection and recording in English primary care settings have not been researched in detail. We are undertaking qualitative interviews to better understand how PH is tested for and diagnosed, and the factors that affect how this is done.  This study explores the barriers to, and facilitators of, improved uptake of PH assessment in English primary care settings.

Approach

We are conducting in-depth semi-structured interviews exploring how multidisciplinary primary care health professionals, involved in BP measurement, check for and manage PH in general practice. Participants are being identified from our related national survey exploring measurement and management of PH. Participants are being purposively sampled to maximise sample variance across professional role, age, sex, time at the practice, GP practice characteristics, geographical location and whether they do or do not check for PH.

The interview topic guide is designed to determine barriers to, and facilitators of, improved uptake of PH assessment in primary care. We are exploring practitioners’ understanding of who should be tested for PH, views on the potential acceptability of undertaking PH assessments using sit-to-stand and/or supine-to-stand approaches, diagnostic thresholds applied, and treatment options following diagnoses. Individual remote semi-structured interviews are in progress using Microsoft Teams. Interviews are being transcribed verbatim, checked for accuracy, and anonymised. Thematic analysis is underway using NVivo (QSR International Pty Ltd. 2020).

Findings

Interviews are currently in progress. Interim results suggest that, staff check for PH when patients report fatigue or have a chronic condition, such as diabetes. Despite awareness of guidelines, various diagnostic definitions are provided, and measurement protocols vary between participants. A sit-to-stand measurement is regarded as being more feasible than supine-to-stand measurements due to time limitations and to mobility of patients. Full findings will be presented to the conference.

Consequences

To our knowledge, this is the first study to explore barriers to, and facilitators of, PH assessment in English primary care settings. Findings from this study will inform national guidelines and a future clinical trial to detect, and guide the management of, people living with PH.

Submitted by:

Rosina Cross

Funding acknowledgement:

This study is funded by National Institute for Health and Care Research, School for Primary Care Research