University of Liverpool, Liverpool, UK.
NIHR Applied Research Collaborative North East and North Cumbria, Cumbria, UK.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241272026. doi: 10.1177/21501319241272026.
People in low socioeconomic circumstances are more susceptible to dyslipidemia and cardiovascular disease than those living in more affluent populations. Limited healthcare access and low preventive care uptake widen health inequalities. Understanding how primary care can better serve socioeconomically disadvantaged communities is urgently needed.
To explore lipid management delivery in socioeconomically disadvantaged areas and identify barriers and enablers for lipid optimization for socioeconomically disadvantaged populations.
Individual semi-structured remote interviews with clinicians, purposively recruited from primary care practices serving extremely socioeconomically disadvantaged communities in Northern England, UK, who were involved in the delivery and organization of lipid management. Interviews were recorded, transcribed, and analyzed thematically following framework analysis.
Fifteen interviews were undertaken. Five themes emerged: complex and multimorbid patients with competing priorities, limited access and follow-up to supporting services, being flexible and working beyond guidelines, high workload with inadequate staff support, and the need for care integrity and sustainable support.
The findings of this study have been fed back to the delivery of the national program to improve cardiovascular health. Socioeconomically disadvantaged communities have complex health needs posing risks of multimorbidity but living with low health literacy, competing demands upon time, and financial constraints. Clinicians are willing to adapt services but a lack of guidance for care and funded services remains a significant barrier to targeted service delivery. Research is needed to inform the effectiveness and acceptability of interventions for lipid management tailored for those experiencing low socioeconomic disadvantage.
与生活在较富裕人群中的人相比，社会经济条件较差的人更容易出现血脂异常和心血管疾病。有限的医疗保健机会和较低的预防保健利用率扩大了健康不平等。迫切需要了解初级保健如何更好地为社会经济处境不利的社区服务。
探索社会经济弱势群体地区的血脂管理服务，并确定为社会经济弱势群体实现血脂优化的障碍和促进因素。
对英国英格兰北部极度社会经济弱势群体地区初级保健实践中的临床医生进行了个体半结构化远程访谈，他们参与了血脂管理的提供和组织。对访谈进行了录音、转录，并采用框架分析法进行了主题分析。
共进行了 15 次访谈。出现了五个主题：具有竞争优先级的复杂和多病共存患者、有限的获得和后续支持服务的机会、灵活并超越指南工作、工作量大但员工支持不足，以及需要护理完整性和可持续支持。
本研究的结果已反馈给改善心血管健康的国家计划的实施。社会经济弱势群体的健康需求复杂，存在多种疾病的风险，但同时健康素养较低、时间上存在竞争需求以及经济限制。临床医生愿意调整服务，但护理指导和资金支持服务的缺乏仍然是有针对性服务提供的一个重大障碍。需要研究针对经历社会经济劣势的人群量身定制的血脂管理干预措施的有效性和可接受性。
