Table 1 Primary care providers’ perceptions of key barriers to completing ambulatory blood pressure monitoring and home blood pressure monitoring^a

Psychological and physical capability

• Do not know how to order the test

• Do not know how to place ABPM device on patients

• Do not know how to interpret ABPM results

• Insufficient training in how to explain results to patients

• Lack of awareness of guidelines

• Lack of knowledge about the indications for testing

• Do not know how to train patients to conduct HBPM testing

• Do not know how to review and interpret HBPM results

• Do not know the protocol for HBPM testing

Physical and social opportunity

• Complicated process to get insurance coverage

• Out-of-pocket costs

• Complex logistics of ordering the test

• Limited access to ABPM testing

• Cost of ABPM equipment

• Lack of staff time to handle the process

• Lack of physician time to communicate the need and process to patients

• Lack of physician time to manage and interpret the data

• Out-of-pocket cost of HBPM device

• Low reimbursement to physicians

• Lack of time to train patients in HBPM protocol

• Lack of time to review HBPM results

• Lack of time to follow-up on technical and clinical problems arising during measurement

Reflective and automatic motivation

Provider perceptions that:

• Patients will be unwilling to perform the test

• Patients will be unable to complete the test due to discomfort and lack of time to return the device

• Test results will not be accurate due to patient non-compliance with testing protocol

• Test results will not be accurate due to inconsistencies in how data are cleaned and interpreted

• Testing is not cost-effective

• Test results will not be sufficient to exclude white-coat hypertension

• Test will not improve patient outcomes

• Test will lead to unnecessary delays in hypertension treatment

Provider perceptions that:

• Patients will be unable to complete HBPM testing due to low health literacy, time requirement, intrusiveness of testing, requirement of a routine, or requirement to bring HBPM results to the office

• Test results will not be accurate due to use of invalid HBPM devices

• Test results will not be accurate due to patient non-compliance with HBPM protocol (e.g., wrong cuff size, wrong timing of blood pressure readings)

• Test results will not be accurate due to patient factors such as body habitus

• Testing could increase patient anxiety and hence, accuracy of test results