Williams Kendra N, Tenorio-Mucha Janeth, Campos-Blanco Karina, Underhill Lindsay J, Valdés-Velásquez Armando, Herbozo Antonia Fuentes, Beres Laura K, de las Fuentes Lisa, Cordova-Ascona Lucy, Vela-Clavo Zoila, Cuentas-Canal Gonzalo Mariano, Mendoza-Velasquez Juan Carlos, Paredes-Barriga Sonia Mercedes, Hurtado La Rosa Raquel, Williams Makeda, Geng Elvin H, Checkley William, Gittelsohn Joel, Davila-Roman Victor G, Hartinger-Peña Stella M
Department of International Health, Social and Behavioral Interventions Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
PLOS Glob Public Health. 2024 Aug 19;4(8):e0002404. doi: 10.1371/journal.pgph.0002404. eCollection 2024.
Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru. A participatory stakeholder workshop (October 2021) and 21 in-depth interviews (October 2021-March 2022) were conducted with 55 healthcare professionals (i.e., doctors, nurses, midwives, dentists, nutritionists), followed by a deductive qualitative analysis of transcripts and notes. Participating healthcare providers indicated that low prioritization and lack of national policies for hypertension care have resulted in limited funding and lack of societal-level prevention efforts. Additionally, limited cultural consideration, both in national guidelines as well as by some providers in Puno, results in inadequate care that may not align with local traditions. Providers highlighted that patient care is also hampered by inadequate distribution and occasional shortages of medications and equipment, as well as a lack of personnel and limited opportunities for training in hypertension. Multiple incompatible health information systems, complicated referral systems, and geographic barriers additionally hinder continuity of care and care seeking. Insights gained from health providers on the healthcare system in Puno provide essential contextual information to inform development of organizational-level strategies necessary to improve provider and patient behaviors to achieve better hypertension care outcomes.
传统的针对患者和医疗服务提供者层面的高血压干预措施已被证明不足以遏制高血压这一全球发病和死亡的主要原因。需要采取系统层面的干预措施，以应对社会生态框架中影响高血压控制的各种因素，这是一个研究不足的课题，在秘鲁等低收入和中等收入国家（LMICs）尤为突出。为了为这类干预措施提供依据，我们试图确定秘鲁普诺市高血压护理的关键卫生系统障碍。我们与55名医疗保健专业人员（即医生、护士、助产士、牙医、营养师）举办了一次参与性利益相关者研讨会（2021年10月）并进行了21次深入访谈（2021年10月至2022年3月），随后对访谈记录和笔记进行了演绎定性分析。参与的医疗服务提供者表示，对高血压护理的低优先级和缺乏国家政策导致资金有限，且缺乏社会层面的预防措施。此外，国家指南以及普诺市的一些医疗服务提供者在文化考量方面有限，导致护理不足，可能不符合当地传统。医疗服务提供者强调，药物和设备的分配不足以及偶尔的短缺，以及人员短缺和高血压培训机会有限，也阻碍了患者护理。多个不兼容的健康信息系统、复杂的转诊系统和地理障碍进一步阻碍了护理的连续性和就医行为。从医疗服务提供者那里获得的关于普诺市医疗系统的见解提供了重要的背景信息，为制定组织层面的策略提供依据，这些策略对于改善医疗服务提供者和患者的行为以实现更好的高血压护理结果至关重要。
