Lambert-Kerzner Anne, Havranek Edward P, Plomondon Mary E, Albright Karen, Moore Ashley, Gryniewicz Kelsey, Magid David, Ho P Michael
Denver Veterans Affairs Medical Center, CO 80220, USA.
Circ Cardiovasc Qual Outcomes. 2010 Nov;3(6):668-74. doi: 10.1161/CIRCOUTCOMES.110.949800. Epub 2010 Oct 5.
Few studies have investigated the effectiveness of multifaceted interventions from the study participants' perspective. We conducted qualitative interviews to understand patients' experiences with a multifaceted blood pressure (BP) control intervention involving interactive voice response technology, home BP monitoring, and pharmacist-led BP management. In the randomized study, the intervention resulted in clinically significant decreases in BP.
We used insights generated from in-depth interviews from all study participants randomly assigned to the multifaceted intervention or usual care (n=146) to create a model explaining the observed improvements in health behavior and clinical outcomes. The data were analyzed using qualitative content analysis methods and consultative and reflexive team analysis. Six explanatory factors emerged from the patients' interviews: (1) improved relationships with medical personnel; (2) increased knowledge of hypertension; (3) increased participation in their health care and personal empowerment; (4) greater understanding of the impact of health behavior on BP; (5) high satisfaction with technology used in the intervention; and, for some patients, (6) increased health care utilization. Eighty-six percent of the intervention patients and 62% of the usual care patients stated that study participation had a positive effect on them. Of those expressing a positive effect, 68% (intervention) and 55% (usual care) reached their systolic BP goal.
Establishing bidirectional conversations between patients and providers is a key element of successful hypertension management. Home BP monitoring coupled with interactive voice response technology reporting facilitates such conversations.
很少有研究从研究参与者的角度调查多方面干预措施的有效性。我们进行了定性访谈，以了解患者在一项涉及交互式语音应答技术、家庭血压监测和药剂师主导的血压管理的多方面血压控制干预中的体验。在随机研究中，该干预导致血压出现临床上的显著下降。
我们利用对所有随机分配到多方面干预组或常规治疗组的研究参与者（n = 146）进行深入访谈所获得的见解，创建了一个模型，以解释在健康行为和临床结果方面观察到的改善情况。使用定性内容分析方法以及协商和反思性团队分析对数据进行了分析。患者访谈中出现了六个解释因素：（1）与医务人员的关系改善；（2）高血压知识增加；（3）对医疗保健的参与度和个人赋权增加；（4）对健康行为对血压影响的理解加深；（5）对干预中使用的技术高度满意；以及，对一些患者来说，（6）医疗保健利用率提高。86%的干预组患者和62%的常规治疗组患者表示参与研究对他们有积极影响。在那些表示有积极影响的患者中，68%（干预组）和55%（常规治疗组）达到了收缩压目标。
在患者和提供者之间建立双向对话是成功管理高血压的关键要素。家庭血压监测与交互式语音应答技术报告相结合有助于此类对话。
