Physicians and other health professionals at the Perelman School of Medicine at the University of Pennsylvania embraced the idea BP refresher training to continue to provide optimal patient care. As refresher training began, many were surprised that they were getting steps wrong and missing steps when measuring a patient’s blood pressure. They realized they did need BP refresher training because many may not have been trained properly in the first place or had forgotten some of the steps, said AMA member Jordana Cohen, MD. By completing online BP refresher training, physicians and other health professionals can close that gap.
In 2019, the AMA and American Heart Association (AHA) launched an online module that provides an engaging and interactive opportunity to refresh BP measurement skills. Powered by Target: BP™, the online module, “Achieving Accuracy: BP Measurement,” creates a comprehensive and standardized training approach to help ensure every health professional within the U.S. is competently trained to measure BP consistently and accurately every time.
“From a qualitative standpoint, we've received a lot of very positive feedback from providers throughout the health system that this BP refresher training is something that we have great need for,” said Dr. Cohen, a nephrologist and Assistant Professor of Medicine and Epidemiology in the Renal-Electrolyte and Hypertension Division and Department of Biostatistics, Epidemiology, and Informatics at the Perelman School of Medicine at the University of Pennsylvania.
The online learning module “has helped to improve the awareness that people are not checking blood pressure correctly, and that it needs to be checked better,” she said, adding that the BP refresher training provides a host of benefits for physicians and other health professionals across the board.
“We aren’t controlling blood pressure well enough in any health system right now, but our health system has identified that as an important issue that we’re working on improving—both in the primary care practices and with some specialty practices,” said Dr. Cohen. “We need to measure blood pressure better. One big part of why we’re not controlling blood pressure adequately is physician inertia due to a lack of trust in the quality of the blood pressures that we get.”
“There’s a lot of concern for white coat hypertension being part of that, but a large part of it is just not trusting the quality of the initial pressure measurement,” she said, adding that the BP refresher training has helped to reduce that lack of trust because physicians are aware that nurses, medical assistants and other care team members are completing the BP refresher training.
BP refresher training also leads to objective changes because now physicians and other health professionals can see the quality of the blood pressures being checked. For example, the health system can measure the frequency with which a BP measurement has been repeated when it is elevated instead of performing only one blood pressure check.
It shows that medical assistants (MAs) or other members of the care team “are doing a better job at it, and they themselves are trusting their own readings more now that they’ve had this refresher,” said Dr. Cohen.
Learn more from the AMA about the need for BP refresher training for all health professionals.
Launching the refresher training for everyone also helped departments identify “what tools we need in our clinic to help us do this better in terms of fixing the triage process versus allowing MAs time to do it correctly, repeating measurements and if they’re not being repeated, making sure that they’ve got the appropriate facilities to be able to,” said Dr. Cohen, adding that BP measurement reeducation allowed them to also implement changes needed to enhance care.
After attending a primary care lecture, one primary care team working on integrating what they learned from the module found one big challenge: trying to get a patient positioned correctly.
“To have a patient be able to sit appropriately with their feet flat on the floor, back supported, arm at heart level and supported, they would need to be in a position where if the provider were to open the door they would be slamming the person’s knees,” she said. “There were very few options and we’ve had similar issues all over the health system, where there’s some aspect of the space that doesn’t provide the necessary environment to do a really good blood pressure check.”
“Other examples include BP devices attached to the wall next to an exam table, where the patient’s back and arm can’t be supported, and their feet can’t touch the ground,” said Dr. Cohen.
While not fully linked to the online learning module, physicians and other health professionals have increased the adoption of self-measured blood pressure(SMBP) monitoring, identifying “the need for improved quality of blood pressure measurements, driven by a separate team in parallel with our in-office blood pressure measurement team,” said Dr. Cohen.
“It really helps to get a lot more people engaged in doing home blood pressure monitoring by being part of that e-learning module,” she said. “It also empowered people to feel more confident in training patients to appropriately measure their own blood pressure at home.”
Blood pressure refresher training is vital for ensuring all health professionals measure BP accurately and consistently every time. The 2017 hypertension guideline from the American College of Cardiology and AHA recommends that health professionals are periodically retrained on BP measurement techniques. It can help all physicians and health professionals.
“It is important to emphasize that BP refresher training is great for people across all levels—it’s really appropriate for MDs through MAs [medical assistants] and RNs,” said Dr. Cohen. “Everybody has something to gain from this program. It really isn’t just something that should be focused at MAs.”
The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to help manage their patients’ high BP. These resources are available to all physicians and health systems as part of Target: BP, a national initiative co-led by the AMA and AHA.