Clinicians' and Patients' Perspectives on Hypertension Care in a Racially and Ethnically Diverse Population in Primary Care.
Clinicians' and Patients' Perspectives on Hypertension Care in a Racially and Ethnically Diverse Population in Primary Care.
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DOI：
10.1001/jamanetworkopen.2023.0977
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发表时间：
2023-02-01
影响因子：
13.8
通讯作者：
Choudhry, Niteesh K.
中科院分区：
文献类型：
--
作者：
Lauffenburger, Julie C.;Barlev, Renee A.;Khatib, Rasha;Glowacki, Nicole;Siddiqi, Alvia;Everett, Marlon E.;Albert, Michelle A.;Keller, Punam A.;Samal, Lipika;Hanken, Kaitlin;Sears, Ellen S.;Haff, Nancy;Choudhry, Niteesh K.
在不同种族和民族的初级保健人群中，患者和临床医生对高血压控制和管理的看法是什么？在这项对15名患者和15名临床医生的定性研究中，参与者认为自我管理（特别是生活方式的改变）应该得到更多的关注；例如，他们表达了自我管理活动的困难，特别是生活方式的改变，以及对加强药物治疗和后续护理建议以及患者自我监测的一些犹豫和变化。目前的高血压健康信息技术工具也被认为是有限的。这项研究的结果表明，由于目前的高血压护理模式被认为是不足的，可能需要更多地关注支持治疗强化和自我管理的方法，特别是通过异步干预。高血压控制仍然不够理想，特别是黑人和西班牙裔或拉丁裔患者。有必要改善高血压管理和设计有效的策略，以有效地提高初级保健的护理质量，特别是对这些高危人群。很少有研究专门探讨初级保健提供者（pcp）和患者对血压管理的看法。在种族和民族多样化的卫生保健系统中，检查临床医生和患者对高血压控制障碍和促进因素的看法。本定性研究于2020年10月1日至2021年3月31日在美国一个大型城市医疗保健系统中进行，研究对象是来自不同种族和民族人群的高血压诊断患者，目的是为了一系列高血压药物使用高血压控制，以及实践pcp。在2021年6月至2022年2月期间，采用浸没结晶法进行了分析。通过半结构化定性访谈，探讨了管理血压的观点，包括药物依从性和生活方式，强化的考虑因素，以及使用健康信息技术工具治疗高血压的经验和差距。这些审查周期一直持续到所有数据都被检查并确定了有意义的模式。对30名参与者进行了访谈：15名患者（平均[SD]年龄58.6[16.2]岁；10名女性[67%]和9名黑人患者[60%]）和15名临床医生（14名pcp和1名医疗助理；8名女性[53%]）。11例患者（73%）血压控制不理想。参与者报告了广泛的高血压护理经验，甚至在同一诊所和卫生保健系统。确定了与初级保健中不同种族和民族患者高血压管理相关的五个主题：(1)自我管理活动困难，特别是生活方式改变；(2)临床医生和患者的用药犹豫加剧；(3)改变用药后的时间和随访；(4)血压自我监测建议和摄取的变化；(5)当前卫生信息技术工具的特定功能有限。在这项关于pcp和患者对高血压控制的看法的定性研究中，参与者认为应该更多地关注生活方式的改变，而不是高血压药物治疗，特别是对少数民族和种族群体的患者。与会者还对卫生信息技术工具支持日益不同步的高血压护理的现有功能表示关切。需要更有意识的方式来支持治疗强化、自我保健和随访护理，以改善初级保健中不同种族和民族人群的高血压管理。这项对15名患者和15名临床医生的定性研究检查了在种族和民族多样化的卫生保健系统中高血压控制的障碍和促进因素。
What are patients’ and clinicians’ perspectives on hypertension control and management in racially and ethnically diverse populations in primary care? In this qualitative study of 15 patients and 15 clinicians, the participants felt that self-management (in particular, lifestyle modifications) should receive more attention; for example, they expressed difficulty with self-management activities, especially lifestyle modifications, and some hesitancy about and variation in intensifying medications and recommendations for follow-up care and patient self-monitoring. Current health information technology tools for hypertension were also thought to be limited. The results of this study suggest that, as current care models for hypertension are thought to be insufficient, more attention may need to be paid to ways to support treatment intensification and self-management, particularly through asynchronous interventions. Hypertension control remains suboptimal, particularly for Black and Hispanic or Latino patients. A need exists to improve hypertension management and design effective strategies to efficiently improve the quality of care in primary care, especially for these at-risk populations. Few studies have specifically explored perspectives on blood pressure management by primary care providers (PCPs) and patients. To examine clinician and patient perspectives on barriers and facilitators to hypertension control within a racially and ethnically diverse health care system. This qualitative study was conducted in a large urban US health care system from October 1, 2020, to March 31, 2021, among patients with a diagnosis of hypertension from a racially and ethnically diverse population, for a range of hypertension medication use hypertension control, as well as practicing PCPs. Analysis was conducted between June 2021 and February 2022 using immersion-crystallization methods. Perspectives on managing blood pressure, including medication adherence and lifestyle, considerations for intensification, and experiences and gaps in using health information technology tools for hypertension, were explored using semistructured qualitative interviews. These cycles of review were continued until all data were examined and meaningful patterns were identified. Interviews were conducted with 30 participants: 15 patients (mean [SD] age, 58.6 [16.2] years; 10 women [67%] and 9 Black patients [60%]) and 15 clinicians (14 PCPs and 1 medical assistant; 8 women [53%]). Eleven patients (73%) had suboptimally controlled blood pressure. Participants reported a wide range of experiences with hypertension care, even within the same clinics and health care system. Five themes relevant to managing hypertension for racially and ethnically diverse patient populations in primary care were identified: (1) difficulty with self-management activities, especially lifestyle modifications; (2) hesitancy intensifying medications by both clinicians and patients; (3) varying the timing and follow-up after changes in medication; (4) variation in blood pressure self-monitoring recommendations and uptake; and (5) limited specific functionality of current health information technology tools. In this qualitative study of the views of PCPs and patients on hypertension control, the participants felt that more focus should be placed on lifestyle modifications than medications for hypertension, particularly for patients from racial and ethnic minority groups. Participants also expressed concerns about the existing functionality of health information technology tools to support increasingly asynchronous hypertension care. More intentional ways of supporting treatment intensification, self-care, and follow-up care are needed to improve hypertension management for racially and ethnically diverse populations in primary care. This qualitative study of 15 patients and 15 clinicians examinged the barriers and facilitators to hypertension control within a racially and ethnically diverse health care system.
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影响因子：
1.6
作者：
Abegaz TM;Shehab A;Gebreyohannes EA;Bhagavathula AS;Elnour AA
通讯作者：
Elnour AA
DOI：
10.1111/jch.13089
发表时间：
2017-10
期刊：
Journal of clinical hypertension (Greenwich, Conn.)
影响因子：
--
作者：
Ferdinand KC;Yadav K;Nasser SA;Clayton-Jeter HD;Lewin J;Cryer DR;Senatore FF
通讯作者：
Senatore FF
影响因子：
5.4
作者：
Chiu, Nicholas;Lauffenburger, Julie;Choudhry, Niteesh
通讯作者：
Choudhry, Niteesh
影响因子：
39
作者：
Morawski, Kyle;Ghazinouri, Roya;Choudhry, Niteesh K.
通讯作者：
Choudhry, Niteesh K.
影响因子：
8.3
作者：
Choudhry, Niteesh K.;Kronish, Ian M.;Hyman, David J.
通讯作者：
Hyman, David J.