Patients' experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study
Patients' experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study
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DOI：
10.1371/journal.pone.0211100
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发表时间：
2019-01-25
期刊：
影响因子：
3.7
通讯作者：
Turner, Elizabeth
中科院分区：
文献类型：
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作者：
Legido-Quigley, Helena;Naheed, Aliya;Turner, Elizabeth
高血压是心血管疾病的主要危险因素，也是全球过早死亡的主要原因。2008年，约40%的成年人被诊断患有高血压，估计到2025年全球将有超过15亿人受到影响。高血压对低收入和中等收入国家造成严重影响，这些国家的发病率较高，卫生系统也较脆弱。这项定性研究探讨了孟加拉国、斯里兰卡和巴基斯坦农村高血压患者的管理和控制经验。我们进行了60次半结构化访谈，每个国家有20名参与者。高血压个体根据年龄、性别和高血压状态招募。总体而言，这三个国家的患者报告的症状非常相似，尽管对高血压的看法各不相同。大多数患者报告对如何预防或治疗高血压的知识不足。据与会者报告，获得保健服务的主要障碍是现有设施服务不足和质量差，药品供应短缺，医生因病人负担重而忙碌，到设施的路途遥远，到达设施后等待时间长。患者还提到，费用是获得服务和坚持服药的障碍。当被问到需要改进的地方时，许多病人都报告了医患关系的重要性，并提到重视那些花时间陪伴他们、提供建议、值得信任的医生。然而，大多数病人报告说，特别是在初级保健一级和政府医院，他们的医生的经验没有达到他们的期望。这三个国家的病人报告说，他们希望获得优质的当地医疗服务，需要获得医生、药品和诊断，并需要降低药品和医疗服务的费用。患者还描述了欢迎他们家附近的医疗保健外展活动。改进的领域可集中于调整社区卫生工作者的活动方向;让家庭成员参与对药物依从性的全面咨询;为卫生保健工作人员提供适当的培训，以便向病人提供有效的控制高血压的信息和服务;加强初级卫生保健和专家服务;改善公共设施中高血压药物的供应;在提供服务时考虑到病人的文化和社会背景;以及便利最脆弱的人获得治疗。
Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertension disproportionally affects low-and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients' experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. Overall, patients' reported symptoms across the three countries were quite similar, although perceptions of hypertension were mixed. The majority of patients reported low knowledge on how to prevent or treat hypertension. The main barriers to accessing health services, as reported by participants, were inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached. Patients also mentioned that cost was a barrier to accessing services and adhering to medication. Many patients, when asked for areas of improvement, reported on the importance of the provider-patient relationship and mentioned valuing doctors who spent time with them, provided advice, and could be trusted. However, most patients reported that, especially at primary health care level and in government hospitals, the experience with their doctor did not meet their expectations. Patients in the three countries reported desire for good quality local medical services, the need for access to doctors, medicine and diagnostics and decreased cost for medication and medical services. Patients also described welcoming health care outreach activities near their homes. Areas of improvement could focus on reorienting community health workers' activities; involving family members in comprehensive counseling for medication adherence; providing appropriate training for health care staff to deliver effective information and services for controlling hypertension to patients; enhancing primary health care and specialist services; improving supplies of hypertensive medication in public facilities; taking into account patients' cultural and social background when providing services; and facilitating access and treatment to those who are most vulnerable.