Rahman Abdul Rashid Abdul, Wang Ji-Guang, Kwong Gary Mak Yiu, Morales Dante D, Sritara Piyamitr, Sukmawan Renan
An Nur Specialist Hospital, No. 19 Medan Pusat Bandar 1 Section 9, 436550 Bandar Baru Bangi, Kajang Malaysia.
Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Asia Pac Fam Med. 2015 Feb 11;14(1):2. doi: 10.1186/s12930-015-0018-3. eCollection 2015.
Hypertension is one of the world's most common health conditions and is a leading risk factor for mortality. Although blood pressure can be modified, there is a large proportion of patients whose blood pressure remains uncontrolled. The aim of this study, termed Edvantage 360°, was to gain a deeper understanding of hypertension management in Asia from the perspective of patients and doctors, and to propose strategies to improve blood pressure control.
Conducted in Hong Kong, Indonesia, Malaysia, the Philippines, South Korea, Taiwan, and Thailand, Edvantage 360° was a mixed-methods observational study that used both qualitative and quantitative elements: qualitative interviews and focus groups with patients (N = 110), quantitative interviews with patients (N = 709), and qualitative interviews with doctors (N = 85).
This study found that, although there is good understanding of the causes and consequences of hypertension among Asian patients, there is a lack of urgency to control blood pressure. Doctors and patients have different expectations of each other and a divergent view on what constitutes successful hypertension management. We also identified a fundamental gap between the beliefs of doctors and patients as to who should be most responsible for the patients' hypertension management. In addition, because patients find it difficult to comply with lifestyle modifications (often because of a decreased understanding of the changes required), adherence to medication regimens may be less of a limiting factor than doctors believe.
Doctors may provide better care by aligning with their patients on a common understanding of successful hypertension management. Doctors may also find it helpful to provide a more personalized explanation of any needed lifestyle modifications. The willingness of the doctor to adjust their patient interaction style to form a 'doctor-patient team' is important. In addition, we recommend that doctors should not attribute ineffectiveness of the treatment plan to patient non-adherence to medications, but rather adjust the medication regimen as needed.
高血压是全球最常见的健康问题之一，也是导致死亡的主要危险因素。尽管血压可以得到控制，但仍有很大一部分患者的血压未能得到有效控制。本研究名为“优势360°”，旨在从患者和医生的角度更深入地了解亚洲地区的高血压管理情况，并提出改善血压控制的策略。
“优势360°”研究在香港、印度尼西亚、马来西亚、菲律宾、韩国、台湾和泰国开展，是一项混合方法的观察性研究，采用了定性和定量两种研究方法：对患者进行定性访谈和焦点小组讨论（N = 110）、对患者进行定量访谈（N = 709）以及对医生进行定性访谈（N = 85）。
本研究发现，尽管亚洲患者对高血压的成因和后果有较好的了解，但在控制血压方面缺乏紧迫感。医生和患者对彼此的期望不同，对于成功的高血压管理的构成也有不同看法。我们还发现医生和患者在谁应该对患者的高血压管理负主要责任这一信念上存在根本差异。此外，由于患者难以遵守生活方式的改变（通常是因为对所需改变的理解不足），坚持药物治疗方案可能不像医生认为的那样是一个限制因素。
医生可以通过与患者就成功的高血压管理达成共识来提供更好的治疗。医生也可能会发现，对任何必要的生活方式改变提供更个性化的解释会有所帮助。医生愿意调整与患者的互动方式以形成“医患团队”很重要。此外我们建议医生不应将治疗方案无效归因于患者不坚持用药，而应根据需要调整药物治疗方案。
