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法国家庭医生实施家庭血压监测:漫长而曲折的道路。

Implementation of home blood pressure monitoring among French GPs: A long and winding road.

机构信息

Université de Lorraine, Département de Médecine Générale, Nancy, France.

Université de Lorraine, École de Santé Publique, Nancy, France.

出版信息

PLoS One. 2019 Sep 11;14(9):e0220460. doi: 10.1371/journal.pone.0220460. eCollection 2019.


DOI:10.1371/journal.pone.0220460
PMID:31509852
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6739115/
Abstract

BACKGROUND: To explore the perception of home blood pressure monitoring (HBPM) by general practitioners (GPs) in everyday practice in order to identify facilitators and barriers to its implementation in daily practice. METHODS: A qualitative study comprising the conduct of six focus groups between October 2016 and February 2017, gathering 41 general practitioners in primary care practice in Lorraine (North Eastern France), with thematic and comprehensive analysis. RESULTS: The first reasons given by GPs to explain their difficulties with HBPM (Home Blood Pressure Monitoring) implementation were the usual lack of time, material and human resources. However, all of these motives masked other substantial limiting factors including insufficient knowledge regarding HBPM, poor adherence to recommendations on HBPM and fear of losing their medical authority. GPs admitted that HBPM use could enhance patient observance and decrease therapeutic inertia. Despite this observation, most GPs used HBPM only at the time of diagnosis and rarely for follow-up. One explanation for GP reluctance towards HBPM may be, along with guidelines regarding hypertension, HBPM is perceived as being a binding framework and being difficult to implement. This barrier was more predominantly observed among aging GPs than in young GPs and was less frequent when GPs practiced in multidisciplinary health centers because the logistical barrier was no longer present. DISCUSSION: In order to improve HBPM implementation in everyday practice in France, it is necessary to focus on GP training and patient education. We must also end "medical power" in hypertension management and turn to multidisciplinary care including nurses, pharmacists and patients.

摘要

背景:为了探索全科医生(GP)在日常实践中对家庭血压监测(HBPM)的认知,以确定在日常实践中实施 HBPM 的促进因素和障碍。

方法:这是一项定性研究,包括在 2016 年 10 月至 2017 年 2 月期间进行的六次焦点小组,参与者为洛林(法国东北部)初级保健实践中的 41 名全科医生,采用主题和综合分析。

结果:GP 解释其在实施 HBPM 方面困难的首要原因通常是缺乏时间、物质和人力资源。然而,所有这些动机都掩盖了其他实质性的限制因素,包括对 HBPM 的知识不足、对 HBPM 建议的遵守程度差以及担心失去医疗权威。GP 承认,HBPM 的使用可以提高患者的观察能力,减少治疗惰性。尽管如此,大多数 GP 仅在诊断时使用 HBPM,很少用于随访。GP 不愿意使用 HBPM 的一个解释可能是,与高血压指南一起,HBPM 被视为一种具有约束力的框架,难以实施。这种障碍在年龄较大的 GP 中比在年轻的 GP 中更为明显,而在多学科健康中心工作的 GP 中则较少,因为不再存在后勤障碍。

讨论:为了改善法国日常实践中 HBPM 的实施,有必要关注 GP 培训和患者教育。我们还必须结束高血压管理中的“医疗权力”,转向包括护士、药剂师和患者在内的多学科护理。

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本文引用的文献

[1]
Self-monitoring of blood pressure to guide titration of antihypertensive medication-a new era in hypertension management?

Cardiovasc Diagn Ther. 2019-2

[2]
Comparing Automated Office Blood Pressure Readings With Other Methods of Blood Pressure Measurement for Identifying Patients With Possible Hypertension: A Systematic Review and Meta-analysis.

JAMA Intern Med. 2019-3-1

[3]
Achieving reliable blood pressure measurements in clinical practice: It's time to meet the challenge.

J Clin Hypertens (Greenwich). 2018-7

[4]
Clinical inertia in the pharmacological management of hypertension: A systematic review and meta-analysis.

Medicine (Baltimore). 2018-6

[5]
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Ann Cardiol Angeiol (Paris). 2018-6

[6]
Do physicians measure patients' blood pressure, and are those measurements reliable?

J Hum Hypertens. 2018-2-8

[7]
Prevalence, risk factors, and prognostic significance of masked hypertension in diabetic patients.

Medicine (Baltimore). 2017-10

[8]
Hypertension and blood pressure variability management practices among physicians in Singapore.

Vasc Health Risk Manag. 2017-7-17

[9]
Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States.

J Am Soc Hypertens. 2017-9

[10]
Ambulatory and home blood pressure monitoring: gaps between clinical guidelines and clinical practice in Singapore.

Int J Gen Med. 2017-7-3

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