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规划在芝加哥实施多级血压控制干预措施:社区和临床视角。

Planning the Implementation of a Multilevel Blood Pressure Control Intervention in Chicago: Community and Clinical Perspectives.

机构信息

Northwestern University Feinberg School of Medicine, Chicago, IL.

Independent Researcher, Chicago, IL.

出版信息

Ethn Dis. 2024 Apr 24;DECIPHeR(Spec Issue):60-67. doi: 10.18865/ed.DECIPHeR.60. eCollection 2023 Dec.

Abstract

OBJECTIVES

Hypertension is associated with high morbidity and mortality. The complications of hypertension disproportionately impact African American residents in Chicago's South Side neighborhood. To inform the implementation of an evidence-based multilevel hypertension management intervention, we sought to identify community member- and clinician-level barriers to diagnosing and treating hypertension, and strategies for addressing those barriers.

METHODS

We conducted 5 focus groups with members of faith-based organizations (FBOs) (n=40) and 8 focus groups with clinicians and administrators (n=26) employed by community health centers (CHCs) located in Chicago's South Side.

RESULTS

Participants across groups identified the physical environment, including lack of access to clinics and healthy food, as a risk factor for hypertension. Participants also identified inconsistent results from home blood pressure monitoring and medication side effects as barriers to seeking diagnosis and treatment. Potential strategies raised by participants to address these barriers included (1) addressing patients' unmet social needs, such as food security and transportation; (2) offering education that meaningfully engages patients in discussions about managing hypertension (eg, medication adherence, diet, follow-up care); (3) coordinating referrals via community-based organizations (including FBOs) to CHCs for hypertension management; and (4) establishing a setting where community members managing hypertension diagnosis can support one another.

CONCLUSIONS

Clinic-level barriers to the diagnosis and treatment of hypertension, such as competing priorities and resource constraints, are exacerbated by community-level stressors. Community members and clinicians agreed that it is important to select implementation strategies that leverage and enhance both community- and clinic-based resources.

摘要

目的

高血压与高发病率和高死亡率相关。高血压的并发症对芝加哥南岸社区的非裔美国居民有不成比例的影响。为了为实施基于证据的多层面高血压管理干预措施提供信息,我们试图确定社区成员和临床医生在诊断和治疗高血压方面的障碍,以及解决这些障碍的策略。

方法

我们在信仰组织(FBO)成员中进行了 5 个焦点小组(n=40),在社区卫生中心(CHC)的临床医生和管理人员中进行了 8 个焦点小组(n=26)。

结果

各小组的参与者均将物理环境(包括缺乏诊所和健康食品的获取途径)确定为高血压的一个风险因素。参与者还确定了家庭血压监测和药物副作用的不一致结果是寻求诊断和治疗的障碍。参与者提出的潜在策略包括:(1)满足患者未满足的社会需求,例如食品安全和交通;(2)提供有意义的教育,使患者能够参与关于管理高血压的讨论(例如,药物依从性、饮食、随访护理);(3)通过社区组织(包括 FBO)协调转介到 CHC 进行高血压管理;(4)建立一个环境,使管理高血压诊断的社区成员能够相互支持。

结论

诊所层面诊断和治疗高血压的障碍,如优先事项和资源限制的竞争,因社区层面的压力而加剧。社区成员和临床医生一致认为,选择利用和增强社区和诊所资源的实施策略非常重要。

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