# Publication phare : présentation de l'article de Family Practice 2022

A Richard

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## To cite this version:

A Richard. Publication phare : présentation de l'article de Family Practice 2022. 22e Congrès national des médecins généralistes enseignants, CNGE, Dec 2022, Lille, France. hal-04959024

HAL Id: hal-04959024

https://uca.hal.science/hal-04959024v1

Submitted on 20 Feb 2025

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Distributed under a Creative Commons Attribution 4.0 International License
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Family Practice, 2022, **XX**, 1-6

https://doi.org/10.1093/fampra/cmac059

Advance access publication 1 June 2022

Epidemiology

OXFORD

# Patients' acceptance of less blood pressure measurement in consultation: a cross-sectional study in general practice

Amélie Richard<fnref n="1" />,<fnref n="2" />,<fnref n="3" />,* , Jeroline Trefond<fnref n="1" />,<fnref n="2" />, Céline Lambert<fnref n="4" />, Guillaume Balandreaud<fnref n="1" />,
Hélène Vaillant-Roussel<fnref n="1" />,<fnref n="2" />,<fnref n="5" />

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<footnote n="1">¹Department of General Practice, Clermont Auvergne University, Clermont-Ferrand, France</footnote>

<footnote n="2">²Research Unit ACCePPT, Clermont Auvergne University, Clermont-Ferrand, France</footnote>

<footnote n="3">³Maison de Santé Pluriprofessionnelle des Batignolles (MSP), Joze, France</footnote>

<footnote n="4">⁴Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France</footnote>

<footnote n="5">⁵DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France</footnote>

<footnote>*Corresponding author: Department of General Practice, UFR Medicine and Medical Professions, University of Clermont Auvergne, 28 Place Henri Dunant, 63000 Clermont-Ferrand, France. Email: Amelie.richard@uca.fr</footnote>
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Introduction

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<footnote>a) SFHTA. La Stratégie Nationale de Santé pour les maladies hypertensives : propositions de la Société Française d'Hypertension Artérielle 2017</footnote>

<footnote>b) Lemercier X, Duhot D, Arnould M, Hebbrecht G. Caractéristiques de la mesure de la pression artérielle par les médecins généralistes français. SFMG</footnote>

<footnote>c) Perrine A L, Lecoffre C, Blacher J, Olié V. L'hypertension artérielle en France : prévalence, traitement et contrôle en 2015 et évolutions depuis 2006. Bull Epidémiol Hebd. 24 avr 2018;2018(10):170-9</footnote>
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## Introduction

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Choosing
Wisely®

An initiative of the ABIM Foundation

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80% des mesures ont 1 biais méthodologique au moins

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Kannel WB, Dawber TR, McGee DL. Perspectives on systolic hypertension. The Framingham study. Circulation 1980;61:1179-82.

Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J 2018;39:3021-104.
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22ᵉ CONGRÈS
NATIONAL

CNGE COLLÈGE ACADÉMIQUE

Exercer
et enseigner
la médecine
générale

14 - 16
DÉCEMBRE
2022

Lille
Grand Palais

## Objectif

Divergences entre patients et médecins généralistes au sujet de l'absence de mesure de la pression artérielle en consultation

Arterial blood pressure not systematically measured during consultations in general practice: doctors' and patients' differing views and feelings

Clarisse Bouchon¹, Julie Favier¹,
Jéromine Trefond¹,²,
Hélène Vaillant-Roussel¹,²,
Philippe Vorilhon¹,², Amélie Richard¹,²,³

1. Département de médecine générale,
UFR de médecine de Clermont-Ferrand,
Université Clermont Auvergne

2. Université Clermont Auvergne,
UPU ACCePPT, 63000 Clermont-Ferrand

3. Maison de santé Les Batignolles,
63350 Joze

amelie.richard@uca.fr
exercer 2022;179:4-10.

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« Vérification » quantitative

Ne pas mesurer la PA en consultation, les patients sont-ils prêts à l'accepte ?
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# Méthodologie

## Étude quantitative, observationnelle, prospective, déclarative par auto-questionnaire anonyme

* 20 cabinets tirés au sort

* 50 questionnaires par cabinet

* 50% de réponses attendues, avec un NSN de 400

* un coefficient de corrélation intraclasse (CIC)

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# Méthodologie

La question 1 concerne les consultations pour un motif aigu (angine, mal de dos récent, etc.).

1) Que ressentez-vous si votre médecin traitant ne vous prend pas la tension artérielle lors d'une consultation pour un motif aigu ?

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La question 2 concerne les consultations de suivi, pour le renouvellement de votre traitement habituel.

2) Que ressentez-vous si votre médecin traitant ne vous prend pas la tension artérielle lors d'une consultation pour le renouvellement de votre traitement habituel ?

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Merci d'avoir pris le temps de répondre à ce questionnaire. Vous pouvez le déposer dans l'une prévue à cet effet.

2/2

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Novembre 2019 à janvier 2020
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## Résultats

<table><caption>Table 1. Patient characteristics.</caption><thead><tr><th></th><th>Total (n = 492)</th></tr></thead><tbody><tr><td>Age (years)</td><td>53.2 ± 16.5</td></tr><tr><td>Age ≥ 65 years</td><td>139 (28.3)</td></tr><tr><td>Female sex</td><td>344 (69.9)</td></tr><tr><td>Medical antecedents</td><td>318 (64.6)</td></tr><tr><td>High blood pressure</td><td>136 (27.6)</td></tr><tr><td>Psychiatric problems</td><td>33 (6.7)</td></tr><tr><td>Chronic treatments</td><td>313 (63.6)</td></tr><tr><td>Antihypertensive</td><td>153 (31.1)</td></tr><tr><td>Psychotropic drugs</td><td>41 (8.3)</td></tr><tr><td>Frequency of consultation</td><td></td></tr><tr><td>1-2 per year</td><td>120 (24.4)</td></tr><tr><td>3-5 per year</td><td>261 (53.0)</td></tr><tr><td>At least 6 times a year</td><td>111 (22.6)</td></tr><tr><td>Urban living environment<sup>a</sup></td><td>253 (51.4)</td></tr><tr><td>Level of education</td><td></td></tr><tr><td>No diploma</td><td>34 (6.9)</td></tr><tr><td>Grade 9</td><td>111 (22.6)</td></tr><tr><td>High school diploma</td><td>108 (21.9)</td></tr><tr><td>Higher education</td><td>239 (48.6)</td></tr></tbody></table>

Data are presented as number of patients (column percentages) or mean ± standard deviation.

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## Analyse univariée

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<footnote>aPlace of living was urban for more 2,000 residents.</footnote>
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22ᵉ CONGRÈS
NATIONAL

Exercer
et enseigner
la médecine
générale

<table><caption>Table 3. Factors associated with patients' perception of the absence of blood pressure measurement during a consultation in general practice in the context of acute and chronic conditions.</caption><thead><tr><th rowspan="2"></th><th colspan="3">Acute conditions</th><th colspan="3">Chronic conditions</th></tr><tr><th>Indifferent or positive perception (n = 294)</th><th>Negative perception (n = 198)</th><th>P</th><th>Indifferent or positive perception (n = 150)</th><th>Negative perception (n = 136)</th><th>P</th></tr></thead><tbody><tr><td>Age (years)</td><td>51.7 ± 16.9</td><td>55.4 ± 15.7</td><td>0.006</td><td>55.8 ± 15.8</td><td>61.9 ± 12.6</td><td>&lt;0.001</td></tr><tr><td>Age</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>&lt;65 years</td><td>217 (61.5)</td><td>136 (38.5)</td><td>0.13</td><td>100 (57.5)</td><td>74 (42.5)</td><td>0.017</td></tr><tr><td>≥65 years</td><td>77 (55.4)</td><td>62 (44.6)</td><td></td><td>50 (44.6)</td><td>62 (55.4)</td><td></td></tr><tr><td>Sex</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Female</td><td>191 (55.5)</td><td>153 (44.5)</td><td>0.006</td><td>102 (52.0)</td><td>94 (48.0)</td><td>0.88</td></tr><tr><td>Male</td><td>103 (69.6)</td><td>45 (30.4)</td><td></td><td>48 (53.3)</td><td>42 (46.7)</td><td></td></tr><tr><td>Medical antecedents</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>117 (67.2)</td><td>57 (32.8)</td><td>0.012</td><td>12 (85.7)</td><td>2 (14.3)</td><td>0.014</td></tr><tr><td>Yes</td><td>177 (55.7)</td><td>141 (44.3)</td><td></td><td>138 (50.7)</td><td>134 (49.3)</td><td></td></tr><tr><td>High blood pressure</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>226 (63.5)</td><td>130 (36.5)</td><td>0.003</td><td>103 (62.8)</td><td>61 (37.2)</td><td>&lt;0.001</td></tr><tr><td>Yes</td><td>68 (50.0)</td><td>68 (50.0)</td><td></td><td>47 (38.5)</td><td>75 (61.5)</td><td></td></tr><tr><td>Psychiatric problems</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>282 (61.4)</td><td>177 (38.6)</td><td>0.008</td><td>134 (52.3)</td><td>122 (47.7)</td><td>0.86</td></tr><tr><td>Yes</td><td>12 (36.4)</td><td>21 (63.6)</td><td></td><td>16 (53.3)</td><td>14 (46.7)</td><td></td></tr><tr><td>Chronic treatments</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>120 (67.0)</td><td>59 (33.0)</td><td>0.017</td><td>10 (90.9)</td><td>1 (9.1)</td><td>0.025</td></tr><tr><td>Yes</td><td>174 (55.6)</td><td>139 (44.4)</td><td></td><td>140 (50.9)</td><td>135 (49.1)</td><td></td></tr><tr><td>Antihypertensive</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>216 (63.7)</td><td>123 (36.3)</td><td>0.007</td><td>97 (64.7)</td><td>53 (35.3)</td><td>&lt;0.001</td></tr><tr><td>Yes</td><td>78 (51.0)</td><td>75 (49.0)</td><td></td><td>53 (39.0)</td><td>83 (61.0)</td><td></td></tr><tr><td>Psychotropic drugs</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>276 (61.2)</td><td>175 (38.8)</td><td>0.040</td><td>130 (52.2)</td><td>119 (47.8)</td><td>0.89</td></tr><tr><td>Yes</td><td>18 (43.9)</td><td>23 (56.1)</td><td></td><td>20 (54.1)</td><td>17 (45.9)</td><td></td></tr><tr><td>Frequency of consultation</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>1-2 per year</td><td>82 (68.3)</td><td>38 (31.7)</td><td>0.019</td><td>16 (55.2)</td><td>13 (44.8)</td><td>0.91</td></tr><tr><td>3-5 per year</td><td>156 (59.8)</td><td>105 (40.2)</td><td></td><td>90 (52.0)</td><td>83 (48.0)</td><td></td></tr><tr><td>At least 6 times a year</td><td>56 (50.5)</td><td>55 (49.5)</td><td></td><td>44 (52.4)</td><td>40 (47.6)</td><td></td></tr><tr><td>Place of residence<sup>a</sup></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Urban</td><td>146 (57.7)</td><td>107 (42.3)</td><td>0.11</td><td>69 (46.3)</td><td>80 (53.7)</td><td>0.045</td></tr><tr><td>Rural</td><td>148 (61.9)</td><td>91 (38.1)</td><td></td><td>81 (59.1)</td><td>56 (40.9)</td><td></td></tr><tr><td>Level of education</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No diploma</td><td>21 (61.8)</td><td>13 (38.2)</td><td>0.60</td><td>15 (55.6)</td><td>12 (44.4)</td><td>0.33</td></tr><tr><td>Grade 9</td><td>64 (57.7)</td><td>47 (42.3)</td><td></td><td>44 (57.9)</td><td>32 (42.1)</td><td></td></tr><tr><td>High school diploma</td><td>70 (64.8)</td><td>38 (35.2)</td><td></td><td>37 (57.8)</td><td>27 (42.2)</td><td></td></tr><tr><td>Higher education</td><td>139 (58.2)</td><td>100 (41.8)</td><td></td><td>54 (45.4)</td><td>65 (54.6)</td><td></td></tr></tbody></table>

Data are presented as number of patients (row percentages) or mean ± standard deviation. Significant P-values in bold are less than 0.05.

14 - 16
DÉCEMBRE
2022

Lille
Grand Palais

Analyse bivariée

<footnote>aPlace of residence was urban for more 2,000 residents.</footnote>
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Facteurs associés au ressenti positif ou négatif

Analyse multivariée

<table><thead><tr><td></td><td>OR</td><td>IC 95%</td><td>p-value</td></tr></thead><tbody><tr><td>Age</td><td>1.012</td><td>[0.994 ; 1.031]</td><td>0.199</td></tr><tr><td>Genre masculin</td><td>0.692</td><td>[0.411 ; 1.163]</td><td>0.165</td></tr><tr><td>HTA</td><td>1.863</td><td>[1.086 ; 3.197]</td><td>0.024</td></tr><tr><td>Problèmes psy</td><td>2.732</td><td>[1.196 ; 6.242]</td><td>0.017</td></tr><tr><td>Consult. 3-5</td><td>0.851</td><td>[0.366 ; 1.982]</td><td>0.709</td></tr><tr><td>Consult. ≥6</td><td>1.244</td><td>[0.510 ; 3.035]</td><td>0.631</td></tr></tbody></table>

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## Discussion

### Forces

- Thème peu traité

- Quantitatif

- Échantillon conséquent et diversifié

### Faiblesses

- Biais d'information

- Biais de sélection
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## Key message

* General practitioners measure blood pressure (BP) to satisfy patients.

* Four of 5 BP measurements have at least one methodological bias.

* Quantitative observational study was conducted using self-questionnaires among patients.

* Majority of patients are in favor of or indifferent to the absence of BP measurement.

* General practice could be more efficient by measuring BP less frequently and better.

## Conclusion

The hypothesis put forward in the qualitative study was confirmed: the majority of patients were in favor of or indifferent to not measuring BP in general practice. General practice could be more efficient by measuring BP less often and, at the same time, measuring BP with greater care.

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LESS is MORE and LESS is POSSIBLE

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