Legido-Quigley Helena, Camacho Lopez Paul Anthony, Balabanova Dina, Perel Pablo, Lopez-Jaramillo Patricio, Nieuwlaat Robby, Schwalm J-D, McCready Tara, Yusuf Salim, McKee Martin
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Fundación Oftalmológica de Santander, Bucaramanga, Colombia.
PLoS One. 2015 Apr 24;10(4):e0122112. doi: 10.1371/journal.pone.0122112. eCollection 2015.
Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients' knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access to care, especially in rural areas.
高血压是全球过早死亡的主要原因，也是心血管疾病最重要的可改变风险因素。有效的筛查项目、与患者的沟通、定期监测以及坚持治疗对于成功管理至关重要，但在面临资源限制的卫生系统中可能具有挑战性。这项定性研究探讨了哥伦比亚患者在高血压检测、治疗和控制方面的知识、态度、行为及就医经历。我们在两个地区对26名高血压患者和4名家庭成员进行了深入访谈和焦点小组讨论。很少有参与者知晓预防高血压的方法。一旦确诊，大多数人表示在服药，但对自己的病情了解甚少，对治疗方案也缺乏认识。渴望与医生进行良好沟通并建立信任关系成为促进坚持服药和定期就医的关键主题。获得治疗的障碍包括药物自付费用、前往医疗机构的交通费用、药物短缺以及难以获得专科护理。一些患者在社交网络、家庭成员和邻居的支持下克服了这些障碍。然而，那些缺乏此类支持的患者感到孤独，难以获得医疗服务。医疗保险计划常被描述为管理混乱，那些参加国家补贴系统的人认为其治疗质量不如强制缴费系统提供的治疗。为改善哥伦比亚的高血压管理应采取的措施包括加强医护人员与患者之间的沟通、采取措施提高对坚持治疗重要性的认识、降低自付费用和交通成本，以及更便捷地获得医疗服务，尤其是在农村地区。
