What, if any, is the magnitude of a difference in white coat effect between doctors and nurses?
Searches
MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL).
Searches of individual journal collections (American Journal of Hypertension, Blood Pressure Monitoring, Hypertension, Journal of Human Hypertension and Journal of Hypertension), recent conference abstracts, and personal reference archives of one of the authors (CEC).
Types of study to be included
Cross sectional studies that reported blood pressures measured by doctors and nurses during the same clinic visit.
Condition or domain being studied
Hypertension/ blood pressure measurement.
Participants/ population
Adults aged 18 or over with or without hypertension.
Intervention(s), exposure(s)
Bllod pressure measured by a doctor.
Comparator(s)/ control
Blood pressure measured by a nurse.
Context
Primary or secondary care clinics.
Outcome(s)
Primary outcomes
Primary outcome measures: mean systolic and diastolic blood pressures measured by nurses and by doctors or the differences between them.
Proportion of patients meeting criteria for white coat hypertension according to doctors and nurses measurements.
Secondary outcomes
None.
Data extraction, (selection and coding)
Data were extracted by two reviewers (CEC & IH) using a standardised electronic form (Microsoft Excel 2007); where studies reported data for hypertensive and normotensive subgroups these were extracted as separate cohorts.
Risk of bias (quality) assessment
Study risk of bias was assessed on the basis of the following criteria:
random order of doctor and nurse measurement,
blinding of doctors and nurses to each others’ measurements, and
blinding of the outcome assessment by use of an automated or random-zero sphygmomanometer.
Strategy for data synthesis
Aggregate (study level) data synthesis.
SEM calcualtion for differences with adjustment by correlation coefficent.
RR calculated for proportional data on white coat hypertension.
Random effects analysis.
Analysis of subgroups or subsets
Normotension vs hypertension.
Male vs female subjects.
Dissemination plans
Conference abstracts and peer reviewed publication
Contact details for further information
Chris Clark
Primary Care Research Group
Institute of Health Service Research
Peninsula Medical School
Smeall Building
St Lukes Campus
Magdalen Rd
Exeter
Devon EX1 2LU
christopher.clark@pms.ac.uk
Organisational affiliation of the review
Primary Care Research Group, Peninsula College of Medicine & Dentistry
http://www.pcmd.ac.uk/research/index.php?group=30
Review team
Dr Chris Clark, PCMD Miss Isabella Horvath, University of Birmingham Medical School Professor Rod Taylor, PCMD Professor John Campbell, PCMD
Anticipated or actual start date
01 June 2011
Anticipated completion date
30 November 2012
Funding sources/sponsors
The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula - PenCLAHRC
http://clahrc-peninsula.nihr.ac.uk/
Conflicts of interest
None known
Language
English
Country
England
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Blood Pressure; Humans; Nurses; Physicians
Date of registration in PROSPERO
19 July 2012
Date of publication of this revision
19 July 2012
Stage of review at time of this submission
Started
Completed
Preliminary searches
No
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Data extraction
Risk of bias (quality) assessment
Data analysis
Prospective meta-analysis
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.
