Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.
Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.
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DOI：
10.5888/pcd13.150383
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发表时间：
2016-02-25
影响因子：
5.5
通讯作者：
Gabbay R
中科院分区：
文献类型：
--
作者：
O'Donnell AJ;Bogner HR;Cronholm PF;Kellom K;Miller-Day M;McClintock HF;Kaye EM;Gabbay R
高血压是心血管和肾脏疾病的一个主要可改变的危险因素，然而高血压得到控制的成年人比例很低。以患者为中心的医疗之家(PCMH)是一种强调以患者为中心、以团队为基础的护理、注重质量和安全的护理提供模式。我们的目标是在一个大型多支付者PCMH示范项目中调查PCMH实施下高血压护理的变化，该项目可能导致高血压控制的改善。2011年1月至2012年1月，PCMH转型倡议在宾夕法尼亚州东南部的17家初级保健诊所进行了118次半结构化访谈。临床医生(n=47)、医务助理(n=26)、办公室管理人员(n=12)、护理经理(n=11)、前台工作人员(n=7)、患者教育者(n=4)、护士(n=4)、社会工作者(n=4)和其他管理人员(n=3)参加了访谈。研究人员使用主题分析来确定与高血压护理相关的主题。临床医生描述了在PCMH下扩大服务以满足越来越多的高血压患者需求的困难，以及对高血压控制的看法与实际表现有何不同。工作人员和办公室管理人员讨论了通过患者教育和个性化护理计划的自我管理支持来实现以患者为中心的高血压护理。他们指出，患者成绩单是有用的工具。所有小组的参与者都讨论了以团队和系统为基础的高血压护理方法。正在进行PCMH转型的实践可能会考虑利益相关者对以患者为中心、基于团队和基于系统的方法的看法，因为他们致力于优化高血压治疗。
Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.