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影响社区卫生中心自我测量血压项目实施的因素:一种实施映射方法。

Factors influencing implementation of a self-measured blood pressure program in community health centers: an implementation mapping approach.

作者信息

Rodriguez Serena A, Velasco-Huerta Fernanda, Sampson-Ansah Mahalia, Garza Ella R, Perkison William B, Mathews Patenne D, Pulicken Catherine, Fernandez Maria E

机构信息

Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center (UTHealth) at Houston School of Public Health, Dallas, TX, United States.

Center for Health Promotion and Prevention Research, UTHealth Houston, Houston, TX, United States.

出版信息

Front Public Health. 2025 Jul 17;13:1485343. doi: 10.3389/fpubh.2025.1485343. eCollection 2025.


DOI:10.3389/fpubh.2025.1485343
PMID:40746695
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12310573/
Abstract

OBJECTIVES: Uncontrolled hypertension is a leading cause of cardiovascular disease, particularly among adults aged 45 years and older. Self-measured blood pressure (SMBP) is an evidence-based intervention that can help patients manage hypertension outside of the clinical setting. We conducted a needs and assets assessment to identify (1) health center adopters and implementers and (2) barriers and facilitators to SMBP adoption and implementation in six community health centers in Texas. METHODS: Data sources included: (1) needs and assets assessment surveys and semi-structured interviews; (2) site visits with participating health centers; and (3) detailed meeting notes and logs. Leaders and administrators from the participating health centers completed a self-administered 56-item survey. We computed descriptive statistics for survey data. For open-ended survey responses, interview data, and meeting notes, team members labeled the reported and observed barriers and facilitators to program implementation. RESULTS: Barriers to SMBP adoption and implementation included staffing shortages, limited funding to procure blood pressure devices, and perceived challenges reaching patients and maintaining engagement in an SMBP program. Facilitators included existing hypertension management guidelines, health center familiarity with SMBP programs, and the use of non-physician team members in hypertension management programs. Adopters included leadership professionals and administrators, and implementers included healthcare providers, and non-physician team members. CONCLUSION: Findings inform our understanding of SMBP program adoption, implementation, and importantly, how to best allocate resources to incorporate SMBP programs into clinical workflows.

摘要

目的:未控制的高血压是心血管疾病的主要原因,在45岁及以上成年人中尤为如此。自我测量血压(SMBP)是一种循证干预措施,可帮助患者在临床环境之外管理高血压。我们进行了一项需求和资产评估,以确定(1)德克萨斯州六个社区卫生中心采用和实施SMBP的机构和人员,以及(2)采用和实施SMBP的障碍和促进因素。 方法:数据来源包括:(1)需求和资产评估调查及半结构化访谈;(2)对参与的卫生中心进行实地考察;(3)详细的会议记录。参与的卫生中心的领导和管理人员完成了一项56项的自填式调查。我们计算了调查数据的描述性统计量。对于开放式调查回复、访谈数据和会议记录,团队成员对报告和观察到的项目实施障碍和促进因素进行了标注。 结果:采用和实施SMBP的障碍包括人员短缺、采购血压设备的资金有限,以及在接触患者和维持患者对SMBP项目的参与度方面存在的感知挑战。促进因素包括现有的高血压管理指南、卫生中心对SMBP项目的熟悉程度,以及在高血压管理项目中使用非医师团队成员。采用者包括领导专业人员和管理人员,实施者包括医疗保健提供者和非医师团队成员。 结论:研究结果有助于我们理解SMBP项目的采用、实施,重要的是,如何最好地分配资源以将SMBP项目纳入临床工作流程。

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本文引用的文献

[1]
Evaluating the Effectiveness of a Patient-Centered, Nonphysician Led Self-Monitoring Blood Pressure Program in a Rural Federally Qualified Health Center.

J Public Health Manag Pract.

[2]
Implementing Self-Measured Blood Pressure Monitoring With Clinical Support: A Qualitative Study of Federally Qualified Health Centers.

J Public Health Manag Pract.

[3]
Implementation Strategies to Improve Blood Pressure Control in the United States: A Scientific Statement From the American Heart Association and American Medical Association.

Hypertension. 2023-10

[4]
How health care professionals handle limited resources in primary care - an interview study.

BMC Health Serv Res. 2023-1-3

[5]
Home Blood Pressure Monitoring.

Am Fam Physician. 2021-9-1

[6]
Physician perceived barriers and facilitators for self-measured blood pressure monitoring- a qualitative study.

PLoS One. 2021

[7]
Prevalence and control rates of hypertension in the USA: 2017-2018.

Int J Cardiol Hypertens. 2020-7-31

[8]
Self-Measured Blood Pressure Monitoring: Program Planning, Implementation, and Lessons Learned From 5 Federally Qualified Health Centers in Hawai'i.

Prev Chronic Dis. 2020-6-25

[9]
Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association.

Circulation. 2020-7-28

[10]
Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies.

Front Public Health. 2019-6-18

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