Abstract

Introduction: Hypertension is prevalent in the emergency department (ED) and more common in the ED than at visits to primary care providers. As a result of this, the American College of Emergency Physicians recommends all adult patients who have a repeated BP ≥ 140/90 mmHg be referred for evaluation. However, existing literature demonstrates referral for elevated BP is suboptimal. Methods: This study was guided conceptually using Cabana et al. (1999) to examine ED provider barriers (knowledge, attitudes, and external factors) that are associated with referral of patients with BP ≥ 140/90 mmHg. A random multidisciplinary sample of ED providers (n = 450) were surveyed using three professional organizations in the United States. The appropriate bivariate and multivariate regression analysis was conducted to examine factors associated with referral. Results: This study achieved a 51% response rate. Knowledge, attitudes, and external factors are associated with referral, yet awareness of the ACEP Policy and provider attitudes were two of the strongest predictors. Providers who reported they have the skills, knowledge, confidence, who take ownership, and perceive less of a medical liability refer 1.4 times more than those who do not perceive these factors (p = 0.001, 95% CI 1.1 - 1.6). In addition, the odds of referral increased by 2.1 for awareness of the ACEP Policy (p = 0.04; 95% CI 1.1 - 4.7). Discussion: Future interventions to improve referral for asymptomatic HTN in ED patients may take into consideration existing provider barriers prior to implantation. The potential the ED provider has in helping to eliminate the adverse outcomes associated with undiagnosed or under-treated HTN in ED patients is significant.

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