Barriers to management of cardiovascular risk in a low-resource setting using hypertension as an entry point
Barriers to management of cardiovascular risk in a low-resource setting using hypertension as an entry point
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DOI：
10.1097/00004872-200401000-00013
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发表时间：
2004-01-01
影响因子：
4.9
通讯作者：
Nordet, P
中科院分区：
文献类型：
--
作者：
Mendis, S;Abegunde, D;Nordet, P
目的 评估资源匮乏环境中卫生保健机构实施绝对风险方法评估高血压患者心血管风险和有效管理高血压的能力 设计和设置 在尼日利亚奥约州的 Egbeda 和 Oluyole 地方政府地区进行了一项描述性横断面研究，随机选择了 56 个初级（n = 42）和二级（n = 2）卫生保健机构和私人卫生保健机构（n = 12）。参与者 1000 人对前往所选机构进行随访的连续已知高血压患者以及在上述随机选择的机构中工作的医疗保健提供者进行了访谈。结果 约三分之二的高血压患者利用初级保健中心进行诊断和随访。大多数机构，特别是初级保健机构，没有进行排除继发性高血压或评估靶器官损伤的实验室和其他检查。研究发现，患者和医疗保健提供者对高血压及其并发症的知识和认识存在相当大的差距。血压控制率较差[收缩压 (SBP) < 140 mmHg 和舒张压 (DBP) < 90 mmHg 的比例为 28%]，并且药物处方模式缺乏证据依据且不具有成本效益。这个低社会经济群体（平均月收入73美元）中的大多数患者（73%）必须自掏腰包全额支付咨询和药物费用。 结论 如果要在资源匮乏的环境中实施评估高血压风险和有效管理高血压的绝对风险方法，则需要采取适当的政策措施来提高卫生保健提供者的能力，提供基本的实验室设施并制定负担得起的融资机制。 (C) 2004 年利平科特·威廉姆斯·威尔金斯。
Objective Assess capacity of health-care facilities in a low-resource setting to implement the absolute risk approach for assessment of cardiovascular risk in hypertensive patients and effective management of hypertensionDesign and setting A descriptive cross-sectional study in Egbeda and Oluyole local government areas of Oyo State in Nigeria in 56 randomly selected primary- (n = 42) and secondary-level (n = 2) health-care and private health-care (n = 12) facilities.Participants One thousand consecutive, known hypertensives attending the selected facilities for follow-up, and health-care providers working in the above randomly selected facilities, were interviewed.Results About two-thirds of hypertensives utilized primary-care centers both for diagnosis and for follow-up. Laboratory and other investigations to exclude secondary hypertension or to assess target organ damage were not available in the majority of facilities, particularly in primary care. A considerable knowledge and awareness gap related to hypertension and its complications was found, both among patients and health-care providers. Blood pressure control rates were poor [28% with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg] and drug prescription patterns were not evidence based and cost effective. The majority of patients (73%) in this low socio-economic group (mean monthly income US$73) had to pay fully, out of their own pocket, for consultations and medications.Conclusions If the absolute risk approach for assessment of risk and effective management of hypertension is to be implemented in low-resource settings, appropriate policy measures need to be taken to improve the competency of health-care providers, to provide basic laboratory facilities and to develop affordable financing mechanisms. (C) 2004 Lippincott Williams Wilkins.