Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
BMJ Open. 2022 Jul 8;12(7):e062128. doi: 10.1136/bmjopen-2022-062128.
Hypertension is a common cause of cardiovascular morbidity and mortality. Although hypertension can be effectively controlled by blood pressure-lowering drugs, uncontrolled blood pressure is common despite use of these medications. One explanation is therapy non-adherence. Therapy non-adherence can be addressed at the individual level, the level of the healthcare provider and at the healthcare system level. Since the latter two levels are often overlooked, we wished to explore facilitators and barriers on each of these levels in relation to hypertension care for people with hypertension, with a specific focus on therapy adherence.
Qualitative study using focus groups of healthcare providers. Data were analysed using the theoretical domains framework (TDF) and the behaviour change wheel.
Participants were from a highly urbanised city environment (the Hague, Netherlands), and included nine primary care physicians, six practice nurses and five secondary care physicians involved in hypertension care.
Nine domains on the TDF were found to be relevant at the healthcare provider level ('knowledge', 'physical, cognitive and interpersonal skills', 'memory, attention and decision processes', 'professional, social role and identity', 'optimism', 'beliefs about consequences', 'intention', 'emotion' and 'social influences') and two domains ('resources' and 'goals') were found to be relevant at the system level. Facilitators for these domains were good interpersonal skills, paying attention to behavioural factors such as medication use, and the belief that treatment improves health outcomes. Barriers were related to time, interdisciplinary collaboration, technical and financial issues, availability of blood pressure devices and education of people with hypertension.
This study highlighted a need for better collaboration between primary and secondary care, for more team-based care including pharmacists and social workers, tools to improve interpersonal skills and more time for patient-healthcare provider communication.
高血压是心血管发病率和死亡率的一个常见原因。尽管降压药物可以有效控制高血压，但尽管使用这些药物，血压仍无法得到有效控制。其中一个解释是治疗不依从。治疗不依从可以在个人层面、医疗服务提供者层面和医疗系统层面上得到解决。由于后两个层面经常被忽视，我们希望探讨与高血压患者的高血压护理相关的每个层面上的促进因素和障碍因素，特别关注治疗依从性。
使用医疗服务提供者焦点小组的定性研究。使用理论领域框架（TDF）和行为改变轮分析数据。
参与者来自高度城市化的城市环境（荷兰海牙），包括九名初级保健医生、六名执业护士和五名参与高血压护理的二级保健医生。
在医疗服务提供者层面，发现 TDF 的九个领域与高血压护理相关（“知识”、“身体、认知和人际技能”、“记忆、注意力和决策过程”、“专业、社会角色和身份”、“乐观”、“信念后果”、“意图”、“情绪”和“社会影响”），而两个领域（“资源”和“目标”）与系统层面相关。这些领域的促进因素是良好的人际交往能力，关注行为因素，如药物使用，以及治疗可以改善健康结果的信念。障碍与时间、跨学科合作、技术和财务问题、血压设备的可用性以及高血压患者的教育有关。
这项研究强调了初级保健和二级保健之间更好的协作、更多的团队为基础的护理、包括药剂师和社会工作者的团队护理、提高人际交往能力的工具以及更多的医患沟通时间的必要性。
