Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
PLoS One. 2019 Jan 25;14(1):e0211100. doi: 10.1371/journal.pone.0211100. eCollection 2019.
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.
高血压是心血管疾病的主要风险因素,也是导致全球人口过早死亡的主要原因。2008 年,约有 40%的成年人被诊断患有高血压,预计到 2025 年,全球将有超过 15 亿人受到影响。高血压在中低收入国家的影响更为严重,这些国家的患病率更高,卫生系统更为脆弱。本研究采用定性方法,探讨了孟加拉国、斯里兰卡和巴基斯坦农村地区高血压患者的管理和控制经验。我们在每个国家进行了 60 次半结构化访谈,每个国家有 20 名参与者。根据年龄、性别和高血压状况招募高血压患者。总体而言,三国患者的报告症状非常相似,但对高血压的认识存在差异。大多数患者报告说,他们对如何预防或治疗高血压的知识了解不足。参与者报告的获取卫生服务的主要障碍包括服务不足和现有设施质量差、药品供应短缺、由于患者人数众多导致医生忙碌、前往医疗机构的距离长以及到达医疗机构后需要长时间等待。患者还提到,费用是获得服务和坚持用药的障碍。许多患者在被问及需要改进的方面时,都表示重视医患关系,并提到他们希望医生能花时间与他们交流、提供建议并值得信赖。然而,大多数患者报告说,尤其是在初级保健水平和政府医院,他们与医生的就诊体验并不符合他们的期望。三国患者都报告说,他们希望获得高质量的当地医疗服务,需要能够接触到医生、药物和诊断,希望降低药物和医疗服务的费用。患者还描述了欢迎在家附近开展医疗保健外联活动。改进的重点可以放在重新定位社区卫生工作者的活动上;让家庭成员参与全面的药物依从性咨询;为卫生保健工作人员提供适当的培训,以便为患者提供有效的高血压控制信息和服务;加强初级保健和专科服务;改善公共设施中高血压药物的供应;在提供服务时考虑患者的文化和社会背景;为最脆弱的人群提供便利的获取途径和治疗机会。
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