Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2023 Feb 1;6(2):e230977. doi: 10.1001/jamanetworkopen.2023.0977.
Hypertension control remains suboptimal, particularly for Black and Hispanic or Latino patients. A need exists to improve hypertension management and design effective strategies to efficiently improve the quality of care in primary care, especially for these at-risk populations. Few studies have specifically explored perspectives on blood pressure management by primary care providers (PCPs) and patients.
To examine clinician and patient perspectives on barriers and facilitators to hypertension control within a racially and ethnically diverse health care system.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study was conducted in a large urban US health care system from October 1, 2020, to March 31, 2021, among patients with a diagnosis of hypertension from a racially and ethnically diverse population, for a range of hypertension medication use hypertension control, as well as practicing PCPs. Analysis was conducted between June 2021 and February 2022 using immersion-crystallization methods.
Perspectives on managing blood pressure, including medication adherence and lifestyle, considerations for intensification, and experiences and gaps in using health information technology tools for hypertension, were explored using semistructured qualitative interviews. These cycles of review were continued until all data were examined and meaningful patterns were identified.
Interviews were conducted with 30 participants: 15 patients (mean [SD] age, 58.6 [16.2] years; 10 women [67%] and 9 Black patients [60%]) and 15 clinicians (14 PCPs and 1 medical assistant; 8 women [53%]). Eleven patients (73%) had suboptimally controlled blood pressure. Participants reported a wide range of experiences with hypertension care, even within the same clinics and health care system. Five themes relevant to managing hypertension for racially and ethnically diverse patient populations in primary care were identified: (1) difficulty with self-management activities, especially lifestyle modifications; (2) hesitancy intensifying medications by both clinicians and patients; (3) varying the timing and follow-up after changes in medication; (4) variation in blood pressure self-monitoring recommendations and uptake; and (5) limited specific functionality of current health information technology tools.
In this qualitative study of the views of PCPs and patients on hypertension control, the participants felt that more focus should be placed on lifestyle modifications than medications for hypertension, particularly for patients from racial and ethnic minority groups. Participants also expressed concerns about the existing functionality of health information technology tools to support increasingly asynchronous hypertension care. More intentional ways of supporting treatment intensification, self-care, and follow-up care are needed to improve hypertension management for racially and ethnically diverse populations in primary care.
高血压控制仍然不理想，尤其是对于黑人和西班牙裔或拉丁裔患者。需要改善高血压管理，并设计有效的策略，以有效提高初级保健的护理质量，特别是针对这些高危人群。很少有研究专门探讨初级保健提供者（PCP）和患者对血压管理的看法。
在一个种族和民族多样化的医疗保健系统中，研究临床医生和患者对高血压控制的障碍和促进因素的看法。
设计、地点和参与者：这项定性研究于 2020 年 10 月 1 日至 2021 年 3 月 31 日在一家大型美国城市医疗保健系统中进行，参与者为来自不同种族和民族的高血压患者，涵盖了各种高血压药物使用情况、高血压控制情况，以及执业 PCP。分析于 2021 年 6 月至 2022 年 2 月期间使用浸入结晶法进行。
使用半结构化定性访谈探讨了管理血压的观点，包括药物依从性和生活方式、强化治疗的考虑因素，以及使用高血压健康信息技术工具的经验和差距。这些审查循环一直持续到检查完所有数据并确定有意义的模式。
共对 30 名参与者进行了访谈：15 名患者（平均[标准差]年龄，58.6[16.2]岁；10 名女性[67%]和 9 名黑人患者[60%]）和 15 名临床医生（14 名 PCP 和 1 名医疗助理；8 名女性[53%]）。11 名患者（73%）血压控制不理想。参与者报告了在高血压护理方面的各种体验，即使在同一诊所和医疗保健系统中也是如此。确定了与初级保健中不同种族和民族患者群体的高血压管理相关的五个主题：（1）自我管理活动困难，尤其是生活方式改变；（2）临床医生和患者都对强化药物治疗犹豫不决；（3）改变药物治疗后调整药物的时间和随访；（4）血压自我监测建议和采用的差异；以及（5）当前健康信息技术工具的特定功能有限。
在这项关于 PCP 和患者对高血压控制看法的定性研究中，参与者认为，应更加注重高血压的生活方式改变，而不是药物治疗，特别是对于来自少数族裔的患者。参与者还对现有健康信息技术工具支持日益异步高血压护理的功能表示担忧。需要更有针对性的方法来支持治疗强化、自我保健和后续护理，以改善初级保健中不同种族和民族人群的高血压管理。
