Community Pharmacies to Offer Hypertension Case Finding ABPM Service

According to the Pharmaceutical Services Negotiating Committee (PSNC) Hypertension is one of the biggest risk factors for CVD (Cardio Vascular Disease) affecting 7 million people and represents a financial burden of approximately £9 billion a year to the NHS.  

The NHS Long Term Plan commits the NHS to reducing morbidity and mortality due to CVD, tackling inequalities and a shift towards prevention strategies. It specifically states that community pharmacy, in collaboration with other providers, will provide opportunities for the public to check on their health through tests for high BP and other high-risk conditions.

The 2019-2024 Community Pharmacy Contractual Framework agreed to pilot a model for detecting undiagnosed CVD in community pharmacies through NHS England and NHS improvement’s Pharmacy Integration Fund (NHSE&I). The majority of the pilot scheme started after March 29th when Covid restrictions were eased. The scheme covered 6 Primary Care Networks (PCN). 35 pharmacies participated in 4 geographies. The pilot sites included rural and urban areas, areas of high ethnicity and areas of mixed deprivation/affluence. The pilot scheme ended in September 2021.

As a result of the, success of the pilot scheme, from 1st October 2021 a new Hypertension case finding service can be offered by UK pharmacies.

Which monitor should a pharmacist purchase?

The Meditech ABPM-06 ABPM monitor meets and exceeds the list of considerations the PSNC suggests pharmacists consider when purchasing an ABPM on their website. The non-exhaustive list includes;                 

  • Is maintenance and training included in the purchase price?

PMS Instruments includes remote support and training. We can also provide a standard operating procedure (SOP)

  • Calibration versus replacement cost and the carbon footprint of both activities;

As a Meditech Official Service Partner we offer a fixed price service and calibration plan after the first two years

  • Frequency/cost of cuff replacement and other consumables;

Meditech cuffs are latex free wipeable and hygienic. Meditech ABPM monitors can use re-chargeable batteries reducing running costs

  • Complexity of use – time taken to use (and explain use, in the case of ABPM);

The easy-to-use Meditech ABPM-06 monitor has been designed with comfort in mind and based on feedback from thousands of customers worldwide

  • For ABPM, the usability of any inclusive software to support set up for the patient and interpretation of readings. Additionally, software and hardware compatibility with existing pharmacy IT systems needs to be considered, e.g., can you plug the meter into a USB port on a PC in the pharmacy.

Meditech ABPM-06 has automatic textual analysis to the latest NICE guideline classifies into 1 of 3 hypertension classifications, as well as number of successful readings determines if recording has been successful. It automatically generates average readings for rapid standard assessment. Comes with a standard USB PC cable for genuine plug and play operation.

  • ABPM must be validated by the British and Irish Hypertension Society (BIHS)

Meditech ABPM-06 is listed on the BIHS website and is FDA and CE approved with an AA grade

The Meditech-06 from PMS Instruments has a whole list of features including free 2 Year Premier Support including remote training and technical support. The Meditech-06 is Supplied with

• Adult (25-32cm) cuff
• Large adult (32-42cm) cuff
• USB PC cable
• CardioVisions analysis software
• Carry pouch, shoulder strap, waist belt
• Quick start user instructions
• 3-year warranty on monitor

To discover even more reasons to purchase a Meditech ABPM-06 from PMS Instruments click HERE

Celebrating Meditech’ s 30 Year Anniversary

2020 is a memorable year and not just because of the COVID-19 pandemic. It also marks the 30th year in business of one of our key partners, Meditech.

Established in Hungary in 1990 Meditech have established a reputation for quality, accuracy and reliability in the design and manufacture of professional cardiovascular medical devices. From small beginnings their Distributor reseller network now covers 5 continents and I am proud to say PMS have been their exclusive UK and Ireland Distributor and Service Partner for over 20 years.

We sold our first Meditech product the Elite PC based ECG back in 1997. The E-Lite was one of the world’s first “plug and play” cost effective 12-lead resting ECG systems. It was popular with GP surgeries and pioneered the use of computers in the recording of ECG’s helping to start the trend for paperless ECG’s.

Next up was the ABPM-04 24 hour ambulatory blood pressure monitor introduced in 2003. This product really put Meditech on the map. Clinically validated to the demanding British Hypertension Society accuracy protocol it launched with the first generation CardioVisions analysis software fully compatible with Windows XP.

With thousands of ABPM-04’s sold worldwide it has become a classic ABPM renowned for its reliability that is still available to this day.

Several of the original monitors we sold over 17 years ago are still in regular use!

Other product milestones include

2000 Merlin ECG Event watch
2000 CardioTens combined ABPM and ECG Event monitor
2003 CardioClip 7 day looping ECG recorder
2004 CardXplore combined ABPM and Holter ECG recorder
2007 ABPM-05
2007 CardioMera 24 Hour Holter ECG
2017 CardiUP3!/12! Second generation Holter ECG
2019 ABPM-06

The latest ABPM-06 is the result of 30 years of product design, engineering precision and of course customer feedback that sets Meditech apart from competitors.

On behalf of everyone at PMS I would like to offer congratulations to the team at Meditech for the achievements and innovations over the last 30 years. We are looking forward to many more.

Life Goes On

It’s very easy to forget that life, although not as we knew it, is still going on. Covid 19 has dominated our lives for the last 6 months and it looks set to continue that way for at least the next 6.

Many GP surgeries have put a temporary hold on offering 24 hour ABPM services

Some are using waiting room BP monitors in place of face to face measurements. Others are not using them at all to reduce the number of patients in the waiting room.

Some are not using the waiting room at all requesting that their patients wait outside the surgery until called directly into the consulting room.

There are so many different ways and we are all trying to provide the best service we can during these strange unprecedented times.

Now could be the perfect time to get your Surgeries BP monitors serviced, if they are not currently being used, so they are ready for when things return to a more normal service.

Some surgeries have decided to wait until they feel comfortable in offering monitoring again.

Either way however you are dealing with the current pandemic we will continue to offer service and calibration of A&D Medical waiting room BP monitors, Meditech ABPM monitors and ECG monitors.

I am pleased to report that for the 27th year running we recently passed the ISO9001 quality standard audit. We are registered to provide repairs and support services for a range of specialised medical instruments.

With us you can be assured that when your monitors are serviced they go through a  comprehensive assessment of up to 70 tests carried out by our own manufacturer trained engineers.

As all monitors are collected and returned by our courier the engineer does not have to enter your premises, therefore maintaining all of your existing covid-19 safety measures.

Despite the Pandemic we are maintaining our fast turnaround time which remains at 3-5 working days. All it to takes to arrange is a quick call or email to us and we will do the rest.

Nothing is normal right now but life does go on and you can be assured we are still here offering you our support and service.

Cleaning Blood Pressure Equipment and Cuffs During COVID-19

As customers start to get ready for the new normal we’ve been receiving a number of calls and emails regarding the safe cleaning of blood pressure cuffs, including 24 hour ABPM cuffs.

Our advice is to use a disinfectant from a reputable brand which complies to the BS EN 14476 standard as this will ensure the spray is effective against a range of viruses including Coronavirus.

Different disinfectants have different contact times, the time the surface must remain wet for the product to be effective. If the solution is not left wet on the surface for the directed time it may not work as effectively.

Before disinfecting cuffs ensure they are dirt and grease free otherwise this may make the disinfectant less effective.

If you are using old style Meditech woven cloth material cuffs we recommend you upgrade to the new hygienic wipe style. ERKA and A&D Medical also have wipe able cuffs in their range.

Purchasing additional cuffs could also provide further protection by leaving time between patient uses.

Even before the outbreak of Covid-19 our TiDi blood pressure cuff barriers were popular. Since the outbreak they have become indispensable for many customers.

Intended for single patient use they are manufactured in latex free FABRICEL tissue fused with a leak proof polyethylene film. They wrap around the patients arm and the cuff is applied over the top ensuring the blood pressure cuff never comes in to direct contact with the skin.

They can be used with all ABPM, digital and manual blood pressure cuffs and are thin enough not to affect measurements. 

They are available in 3 sizes

Adult (TID916114)- 300 barriers are supplied in 6 boxes of 50.

Large Adult (TID916115)- 150 barriers are supplied in 3 boxes of 50.

Paediatric (TID916113)- 300 barriers are supplied in 6 boxes of 50.

For waiting room BP monitors the same disinfectant complying with BS EN 14476 can be used. Single use protective overarm sleeves (AND093) protect the TM-2655P and TM-2657P inner from dirt and liquid and from coming into direct patient contact. Manufactured from latex free polythene they are 40cm long and fit an arm circumference of 38cm.

Review of the Meditech ABPM-06

It’s not that often that Meditech introduce a new ABPM. The last one, the ABPM-05 was introduced in 2007 the year the iPhone was launched. When they do it’s worth the wait.

There is a lot of thought that goes into the design and features customers really want in a new monitor. As well as good design it is important the technical elements are addressed so that the 30 year plus reputation for reliability and accuracy that Meditech have and customers from around the world expect, is maintained.

We’re proud that Meditech chose PMS Instruments and the UK as their first launch partner for the new ABPM-06 so what’s it really like to wear, use and operate?

First impressions are good. It’s got the same familiar look as the ABPM-05 which means it’s compact and light.

It uses the same size and type of wipeable cuffs which means users of the old ABPM-04 and ABPM-05 can use their existing cuffs interchanging between units. The cuffs are durable and easy to wipe clean which is important for patient hygiene.

One major improvement is the type of PC interface cable the new ABPM-06 is supplied with. The old ABPM-04 and ABPM-05 used either a serial interface or USB optoelectronic fibre optic cable which was unique to Meditech. Although repairable these old cables are expensive to replace or purchase new.

As customers frequently want to use their ABPM in more than one treatment room the new ABPM-06 is now supplied with a standard mini USB A mini to USB B PC cable. This resolves any potential cable comms issues as there is only one way the cable will go in.

Meditech have taken the wise decision to integrate the ABPM-06 into their popular CardioVisions analysis software rather than offer a completely new software platform. This means the look and feel of the software, programming, downloading and printing will be familiar to users of the old ABPM-04 and ABPM-05 with no new software to learn.

Programming the ABPM-06 takes seconds and key patient information like name, date of birth and ID is retained in the monitor so there is no doubt who has worn the monitor.

In the interests of customers I have worn a new ABPM-06 twice now and found the monitor comfortable and unobtrusive throughout.

I programmed the monitor to record every 30 minutes during the day and hourly during the night as recommended by the latest NICE guideline NG136.

Of the 40 readings taken over 24 hours all were successful with no errors. I was aware of the monitor going off at night but the new SleepWell® function added to the new AA grade algorithm meant the device wasn’t uncomfortable and the measurement inflation and deflation time was quick.

Downloading the results took seconds and the automatic text reporting, trend graph and presentation of key metrics like average daytime reading value are clear.

Feedback from new and existing customers who have purchased the ABPM-06 since we introduced it has been very positive. For a free demonstration, loan or for more information just call or email us.

The New Meditech ABPM-06

PMS Instruments are pleased to announce the UK launch of the new ABPM-06 24 hour ABPM.

The ABPM-06 is the latest generation premium ambulatory blood pressure monitor from Meditech, technology leaders worldwide in the manufacturing of ambulatory blood pressure monitors since 1990.

It builds on the near 30 year plus reputation and experience of Meditech’ s engineers and maintains the tradition of reliability and accuracy that thousands of customers around the world have come to expect.

The ABPM-06 has all the features customers like in the ABPM-04 and ABPM-05 plus some important new innovations

  1. AA grade Independent clinical validation to 3 separate protocols
  2. Built in voice recording (max 8 x 15 seconds)
  3. Free, all-inclusive software packages
  4. Unique SleepWell® function
  5. Dual valve system for patient safety
  6. Proven technology and long-life reliability

With both the ABPM-04 and ABPM-05 patients could trigger additional measurements by pressing a button. This feature is retained but with the ABPM-06 they can now also record up to 8 x 15 second voice memos.

For the first time patients can now record voice memos of symptoms during the recording for example if they are feeling dizzy and give detailed feedback to their Doctor over the monitoring period. This voice memos are downloaded and stored with the recording on the PC.

The ABPM-06 is A/A clinically validated to the ESH-IP, BIHS and AAMI protocols so accuracy is assured. The extended measurement range gives the doctor a more precise BP profile and overnight dipping and morning surges can easily be identified.

Meditech have designed a unique SleepWell® function to disturb the patient as little as possible during the night. The ABPM-06 won’t repeat failed readings unless necessary. This helps avoid measurements being taken uncomfortably close together.

The ABPM-06 comes with a standard USB cable. Cuff compatibility with earlier versions is maintained.

As you would expect the ABPM-06 is supplied with the popular CardioVisions analysis software which provides detailed automatic reporting and textual analysis.

For existing customers there is no new software to learn. Demonstrations are available and you can buy with confidence direct from PMS Instruments, the exclusive UK and Ireland Meditech authorised distributor since 1997.

New Fixed Price Service Package.

We are pleased to announce the introduction of new Fixed Price Service Plans for selected A&D Medical and Meditech devices including the Meditech ABPM-04/ABPM-05 and A&D TM-2655P/TM-2657P waiting room blood pressure monitors.

PMS Instruments are an approved A&D Medical and Meditech service and repair centre and our new Fixed Price Service Plan includes:-

  • 12 months priority software telephone and remote technical support
  • 12 months remote assist training and installation where applicable
  • Fixed price servicing cost including labour and service parts
  • Fast priority response for all servicing and repairs
  • Loan equipment (subject to availability)
  • FREE preventative maintenance and calibration check
  • Up to 70 point test procedure verifies equipment accuracy, patient safety and reliability
  • Fully insured courier collection and return included
  • Priority turnaround time typically 3-5 working days from receipt of equipment
  • Inclusive annual service and calibration to manufacturer’s specification
  • ISO-9001 Quality Assured service centre and Practice Index approved supplier
  • No need to pay to get this equipment serviced by 3rd party

We use genuine manufacturer approved spare parts, and adhere to recommended preventative and service procedures.

For pricing and to protect your equipment investment and ensure it is accurate, safe and reliable act today by calling 01628 773233 or email support@pmsinstruments.co.uk

Just one call or email is all it takes and we will do the rest.

Meditech CardiUP!3 24 Hour Holter ECG introduced

January 2018 sees the official UK launch of the new Meditech CardiUP!3 Holter ECG.

Continuous full disclosure Holter ECG monitors were first used in the 1970s and typically operate for 24-48 hours recording every single heartbeat during this period. This can mean that upwards of 100,000 beats are recorded over a 24 hour period. They are especially useful if the wearer does not feel or is not aware of the ECG abnormality.

Holter ECG recorders are generally used to investigate suspected symptoms of arrhythmia including palpitations, light-headedness or syncope (partial or complete loss of consciousness), which has not been detected during a shorter 12 lead, surgery based ECG.

Is there still a need for Holter ECG recorders?

NICE clinical guideline Clinical guideline CG180  on Atrial Fibrillation management recommends the use of a 24‑hour ambulatory ECG monitor in patients with suspected asymptomatic episodes or symptomatic episodes less than 24 hours apart  or with suspected paroxysmal atrial fibrillation undetected by standard ECG recording.

What’s different with the CardiUP!3 Holter?

The latest generation CardiUp!3 from Meditech has a large internal memory which means it can record continuous digital full disclosure ECG from 24 hours or for up to 7 days using just 1 AA battery!

The large LCD screen displays real-time ECG which lets you verify ECG quality, ensuring accurate hook up in real time. Connection is by a new standard mini USB connection.

The CardiUP!3 has a manual programming option which means it can be programmed without connection to a PC. This can be useful if a PC is not available or a treatment room is occupied.

The Meditech CardioVisions analysis software supplied with the CardiUP!3 provides automatic beat-by-beat ECG, ST, PQ, QT and HRV analysis and includes pacemaker beat detection. The QRS detection algorithm of the software is 99.9% accurate according to the IEC 60601-2-47 International Standard and AHA and MIT databases and gives rapid automatic ECG annotation and analysis in minutes.

Running costs are minimised thanks to the latest low power electronic design techniques. The CardiUp!3 Holter uses just 1 AA Alkaline or rechargeable battery.

To find out more or to arrange a demonstration just call us on 01628 773233.

Is 24 Hour ABPM Still An Indispensable Tool In The Management Of Hypertension?

Ambulatory Blood Pressure Measurement (ABPM) has been used increasingly in clinical practice over the last 30 years. With the rise and adoption of low cost home blood pressure monitoring is it still an indispensable tool in the management of hypertensives in General Practice?

I first asked this question in an article I wrote for Practice Management magazine in 2010. I concluded that it was but in the intervening years is this still the case?

In the light of clinical developments and the publication of guidelines like NICE Guideline CG127 on Hypertension in 2011 and latest update in November 2016 is it still relevant?

Some background

In recognition of the importance of ABPM, the British Hypertension Society (now the British and Irish Hypertension Society), the European Society of Hypertension and NICE CG127 have all published guidelines for the use and interpretation of ABPM in clinical practice.

Traditionally, hypertensive patients had been assessed using clinic based blood pressure readings by a Nurse or Doctor. This changed in 2011 and recognition was formally given to the importance of using 24 hour ABPM monitoring.

The old “snapshot” approach to blood pressure measurement could give inconsistencies and over-estimate a patient’s blood pressure by anything up to 30mmHg.

The so called White Coat Hypertension, leading to elevated blood pressure is well documented and can lead to unnecessary prescription of hypertensive medicines. This has a profound clinical and financial relevance to Primary Care and can lead to inappropriate diagnosis and treatment. Ambulatory Blood Pressure Monitors provide much more consistent readings over a 24-hour period and give multiple measurements throughout the day and night.

CardioVisions NICE Software keeps it simple.

Modern ABPM software can produce a plethora of statistics and data which even for experienced clinicians can be overwhelming.

As a response to this and in view of the 2011 NICE guidelines we introduced our CardioVisions NICE software. This provided a meaningful textual analysis ensuring clinicians got reporting continuity to a recognised clinical standard as well as importantly saving Doctor and Nurse time. It’s compatible with the Meditech ABPMs and a typical report may read something like this.

“The ABPM was worn by the patient for 24 hours. During this period the average daytime blood pressure was 169/118 and the pulse rate was 88 beats per minute. According to NICE guidelines the patient exhibits stage 2 hypertension. The examination was divided into day 06:00-22:00, night 22:00-06:00. 64 successful readings were taken during the daytime period and the NICE key quality requirement for 14 has been met. During the daytime there were 64 readings (100.0%) above the NICE guideline figure of 135/85. The highest reading was 202/134 recorded at 9:15 22/05/1997. During the night time period 24 successful readings were taken and the average blood pressure was 135/87.”

The detailed stats, graphs and readings are still there for those that want them but the textual analysis summary can be copied and pasted into the patient notes and also attached to popular clinical management systems like EMIS Web and SystmOne. There is no annual licence fee and multiple copies can be installed.

What about home blood pressure monitoring?

The cost of clinically validated home blood pressure monitors has fallen since 2010 and a number of GP Practices have been loaning monitors like the UA-767S-W to patients. Home monitoring is great for the small number of patients that find ambulatory blood pressure monitoring inconvenient or difficult tolerate but it’s not ideal for everyone and can be difficult to manage in practice.

For home blood pressure monitoring NICE recommend patients should measure their blood pressure twice a day, ideally once in the morning and once in the evening, while sitting down. Each time they do this, they should take two readings, 1 minute apart. They should continue to measure their blood pressure twice daily for at least 4 days and ideally for 7 days. Some patients may find this onerous and patient compliance can vary. A 24 hour monitor is only worn for 24 hours!

All the measurements taken after the first day are used to work out average day time blood pressure but again this can be time consuming and may be subject to error.

Whilst home blood pressure monitoring gives multiple readings, it relies on proper patient technique, patient training and compliance for up to seven days to give meaningful results.

As a complementary technique to 24 hour ABPM it can be useful to monitor patients with long term chronic conditions such as diabetes and coronary heart disease.

On the flip side the detail, automatic analysis and reporting, 24 hour ABPM provides with very little user or patient input just isn’t available with home blood pressure monitoring.

Night time readings cannot be recorded and for many 24 hour ABPM remains the “Gold Standard”.

So why doesn’t everyone use 24 hour ABPM?

For some the initial cost is off putting but the cost of 24 hour ABPM monitors has fallen since 2010.

The latest 24 hour BP monitors like the Meditech ABPM-04 and ABPM-05 are reliable with low running costs, long warranties and a low overall cost of ownership.

PMS Instruments now offer a flexible rental ABPM service which means cost can be spread over several months and for a low monthly fee service and calibration is covered.

“Is 24 Hour ABPM Still An Indispensable Tool In Management Of Hypertension?” my answer would still be yes.

To arrange a free trial of one of our latest ABPM monitors and find out for yourself please contact us on 01628 773233.

24/7 ABPM Guidelines Revisited

NICE clinical guideline 127 states that ABPM monitoring is the most accurate method for confirming a diagnosis of hypertension, and its use should reduce unnecessary treatment in people who do not have true hypertension. Originally published in 2013 it was updated in September 2015.

In a recent review with our technical support team I asked them what were the practical questions they were most frequently asked about the guideline and ABPM in general.

I thought I would share the results on our Blog as they may be of interest to other ABPM customers. In no particular order this is what they told me.

Continue reading “24/7 ABPM Guidelines Revisited”