Zaidi Abbas H, Sood Erica, De Ferranti Sarah, Gidding Samuel, Zadokar Varsha, Miller Jonathan, Kazak Anne
Nemours Children's Health Cardiac Center, Wilmington, Delaware.
Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
JAMA Netw Open. 2024 Dec 2;7(12):e2451103. doi: 10.1001/jamanetworkopen.2024.51103.
Despite published guidelines and a prevalence of pediatric hypertension of approximately 3%, less than 25% of affected children are identified, with 60% not receiving any intervention despite detection. Understanding the knowledge and perceptions of parents or caregivers and health care teams is crucial to identify factors that may contribute to these unacceptably low detection rates.
To examine the knowledge and perceptions of parents and health care teams regarding pediatric hypertension to identify common themes contributing to low hypertension detection.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study, interviewed parents of children diagnosed with hypertension who did not follow up within 1 year after diagnosis and health care clinicians (medical assistants, nurses, managers, pediatricians, and nurse practitioners) across 10 clinics in Delaware and Pennsylvania between November 1, 2022, and March 31, 2023.
With the use of an inductive thematic approach, codes were developed and themes identified by multidisciplinary research investigators.
A total of 38 stakeholders (mean [range] age, 43 [25-64] years; 33 [86%] female), including 13 parents and 25 health care clinicians, were interviewed. The parent sample was diverse based on race (5 [46%] Black, 5 [38%] White, and 3 [23%] other race), ethnicity (5 [38%] Hispanic and 8 [62%] non-Hispanic), and Child Opportunity Index (5 [38%] very low or low, 3 [23%] moderate, and 5 [38%] high or very high). Parents and clinicians demonstrated awareness of the significance of pediatric hypertension. Parents thought blood pressure checks were important; however, clinicians often had competing priorities during annual visits. Both groups expressed skepticism about high blood pressure readings, attributing them to situational factors or white coat syndrome. Parents and clinicians shared concerns about medication use and preferred lifestyle change. Parents advocated for further testing, whereas clinicians exhibited varying perspectives on additional diagnostics, emphasizing targeted testing strategies and cautious medication approaches.
In this qualitative study of parents and clinicians, both groups were skeptical of blood pressure readings and expressed concerns about medication use, with a preference for lifestyle changes over medication. Improving detection may require better measurement tools, reassurance about medications, and clear communication on the role of nonpharmacologic treatments, while future interventions should incorporate the perspectives of both parents and clinicians to develop practical strategies for managing pediatric hypertension.
尽管有已发布的指南，且小儿高血压患病率约为3%，但只有不到25%的患病儿童被识别出来，其中60%在被检测出后未接受任何干预。了解家长或照顾者以及医疗团队的知识和看法对于识别可能导致这些低得令人无法接受的检测率的因素至关重要。
研究家长和医疗团队对小儿高血压的知识和看法，以确定导致高血压低检测率的共同主题。
设计、地点和参与者：这项定性研究于2022年11月1日至2023年3月31日期间，对特拉华州和宾夕法尼亚州10家诊所中被诊断为高血压但在诊断后1年内未进行随访的儿童的家长以及医疗临床医生（医疗助理、护士、管理人员、儿科医生和执业护士）进行了访谈。
采用归纳主题法，由多学科研究人员制定编码并确定主题。
共访谈了38名利益相关者（平均[范围]年龄为43[25 - 64]岁；33名[86%]为女性），包括13名家长和25名医疗临床医生。家长样本在种族（5名[46%]黑人、5名[38%]白人、3名[23%]其他种族）、族裔（5名[38%]西班牙裔、8名[62%]非西班牙裔）和儿童机会指数（5名[38%]非常低或低、3名[23%]中等、5名[38%]高或非常高）方面具有多样性。家长和临床医生都意识到小儿高血压的重要性。家长认为血压检查很重要；然而，临床医生在年度就诊时往往有其他优先事项。两组都对高血压读数表示怀疑，将其归因于情境因素或白大衣综合征。家长和临床医生都对药物使用表示担忧，并更倾向于生活方式改变。家长主张进一步检查，而临床医生对额外诊断表现出不同的观点，强调有针对性的检查策略和谨慎的用药方法。
在这项针对家长和临床医生的定性研究中，两组都对血压读数持怀疑态度，并对药物使用表示担忧，更倾向于生活方式改变而非药物治疗。提高检测率可能需要更好的测量工具、对药物的放心以及就非药物治疗的作用进行清晰沟通，而未来的干预措施应纳入家长和临床医生双方的观点，以制定管理小儿高血压的实用策略。
