Allen Caitlin G, Brownstein J Nell, Satsangi Anamika, Escoffery Cam
Boston University, Department of Medicine, 72 E Concord St, Boston, MA 02118. Email:
Emory University, Rollins School of Public Health, Atlanta, Georgia.
Prev Chronic Dis. 2016 Dec 29;13:E179. doi: 10.5888/pcd13.160236.
Rates of hypertension control remain low among underserved populations in the United States; moreover, disparities in hypertension-related cardiovascular disease death are increasing. Community health workers (CHWs) can address barriers to hypertension control among underrepresented and diverse populations. We identify unique roles CHWs play in hypertension self-management and medication adherence.
In 2014, we conducted a mixed methods study with an online survey of 265 CHWs and 23 telephone interviews. The survey and interview guide contained questions about CHWs' roles in hypertension self-management and hypertension medication adherence. We used descriptive statistics to analyze survey data and used inductive thematic analysis for the qualitative data.
CHWs described working in partnership with patients and various health care providers to assist people in hypertension self-management. Roles were flexible and multifaceted but patient-driven. CHWs used various delivery methods to assist patients in overcoming barriers to medication adherence. CHWs interacted with patients primarily through individual clinical sessions or home visits. On average, they visit about 8 times per month, about 40 minutes per visit, over 7 months. CHWs often addressed barriers related to medicine-taking and refills and support patient-provider communications.
Results from this study will help health care professionals, policy makers, and academics better understand the work of CHWs. CHWs are important provider allies for improving hypertension prevention and self-management, especially among underserved and diverse populations in the United States.
在美国，未得到充分服务的人群中高血压控制率仍然很低；此外，与高血压相关的心血管疾病死亡差异正在增加。社区卫生工作者（CHW）可以解决代表性不足和多样化人群中高血压控制的障碍。我们确定了社区卫生工作者在高血压自我管理和药物依从性方面所发挥的独特作用。
2014年，我们进行了一项混合方法研究，对265名社区卫生工作者进行了在线调查，并进行了23次电话访谈。调查和访谈指南包含了关于社区卫生工作者在高血压自我管理和高血压药物依从性方面作用的问题。我们使用描述性统计分析调查数据，并对定性数据进行归纳主题分析。
社区卫生工作者描述了与患者和各种医疗保健提供者合作，协助人们进行高血压自我管理。其作用灵活且多方面，但以患者为导向。社区卫生工作者使用各种提供方式来帮助患者克服药物依从性障碍。社区卫生工作者主要通过个别临床会诊或家访与患者互动。平均而言，他们在7个月内每月约家访8次，每次约40分钟。社区卫生工作者经常解决与服药和续药相关的障碍，并支持患者与提供者之间的沟通。
本研究结果将有助于医疗保健专业人员、政策制定者和学者更好地了解社区卫生工作者的工作。社区卫生工作者是改善高血压预防和自我管理的重要提供者盟友，尤其是在美国未得到充分服务和多样化的人群中。
