Objectives: To describe adherence to the American Academy of Pediatrics' (AAP) 2017 clinical practice guidelines for follow-up after high blood pressure (BP) screening by pediatric and family medicine providers in a Massachusetts healthcare system and to assess differences in receipt of follow-up according to child- and clinic-level factors.

Methods: Electronic health record data were analyzed for children aged 3-17 years who had an outpatient primary care visit during 2018 with a high BP screening (according to AAP guidelines). We classified AAP guideline adherent follow-up as BP follow-up within 6 months after an elevated finding (+2-week buffer) and within 2 weeks after a hypertensive finding (+2-week buffer). Differences in receipt of guideline adherent follow-up by child- and clinic-level factors were assessed via multilevel mixed effects logistic regression models.

Results: The median age of the 4,563 included children was 12 years and 43% were female. Overall, guideline adherent follow-up was received by 17.7% of children within the recommended time interval; 27.4% for those whose index BP was elevated and 5.4% for those whose BP was hypertensive. Modeling revealed older children and those belonging to clinics with more providers, smaller patient panels, and smaller proportion of Medicaid patients were more likely to receive adherent follow-up.

Conclusion: Few children received guideline adherent BP follow-up and most differences in adherence were related to clinic resources. System level interventions are needed to improve BP follow-up.