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Identifying Barriers to Hypertension Care: Implications for Quality Improvement Initiatives

机译：确定高血压护理的障碍：对质量改善计划的意义

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摘要

The role of clinical inertia in the treatment of patients with hypertension was assessed by evaluating health care providers' knowledge, attitudes, and clinical practices regarding hypertension management. A cross-sectional survey was conducted at the Forsyth Medical Group in North Carolina. Participants were physicians (N = 18, 10 sites) and support staff (N = 20, 12 sites), who were surveyed in 2006. Physician and support staff questionnaires consisted of 29 and 15 items, respectively, and were administered by trained interviewers. Though most physicians (94%) cited familiarity with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines and affirmed that hypertension management guidelines are relevant to their patients, no physicians interviewed routinely document patient hypertension management plans. Although 1 in 3 physicians cited the inability to devote enough time to patients for the discussion of hypertension management, physicians predominantly cited patient- and support-staff- related factors as most important to patients not attaining blood pressure (BP) goal. Patient lifestyle modification (89%), education (67%), and medication compliance (56%) were cited as the most important reasons for uncontrolled BP. Only one-third of physicians believe that clinical staff always obtain accurate BP measurements, and 61% believe that resistant hypertension is a reflection of inaccurate BP measurement. Many support staff claimed to be rushed when measuring patient BP, and 65% recommended BP competency training. Contradictions were evident between provider knowledge of hypertension management standards and how this knowledge is applied in clinical practice. Standardized collection of BP is critical to measuring clinical improvement in hypertension. Results are being utilized to develop clinical improvement initiatives including staff education and competency training. (Disease Management. 2008;11:71–77)
机译：通过评估医疗保健提供者有关高血压管理的知识，态度和临床实践，评估了临床惯性在高血压患者治疗中的作用。在北卡罗来纳州的福赛思医疗集团进行了横断面调查。参加者是医生（N = 18，10个站点）和支持人员（N = 20，12个站点），他们在2006年接受了调查。医师和支持人员问卷分别由29和15个项目组成，并由经过培训的访问员进行管理。尽管大多数医生（94％）表示熟悉高血压预防，检测，评估和治疗联合全国委员会的第七次报告（JNC-7）指南，并确认高血压管理指南与患者相关，但没有医生定期接受采访，记录患者高血压管理计划。尽管每3名医生中有1名提到无法将足够的时间用于讨论高血压管理的患者，但医生主要将与患者和支持人员相关的因素列为对未达到血压（BP）目标的患者最重要的因素。改变患者生活方式（89％），受教育程度（67％）和用药依从性（56％）被认为是血压失控的最重要原因。只有三分之一的医生认为临床人员总是能够获得准确的BP测量值，而61％的医生认为耐药性高血压反映了BP测量值不准确。许多支持人员声称在测量患者的BP时很着急，有65％的人建议进行BP能力培训。提供者对高血压管理标准的了解与如何将这些知识应用于临床实践之间存在明显矛盾。标准化的BP收集对于衡量高血压的临床改善至关重要。结果被用于制定临床改善计划，包括员工教育和能力培训。 （疾病管理。2008； 11：71-77）

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  • 来源
    《Disease Management》 |2008年第2期|p.71-77|共7页
  • 作者

    Nan Holland Denise Segraves Victoria O. Nnadi Daniel A. Belletti Jenifer Wogen Steve Arcona;

  • 作者单位

    Nan Holland, R.N., M.P.H.Forsyth Medical Group, Winston-Salem, North Carolina.Denise Segraves, R.N., B.S.N.Forsyth Medical Group, Winston-Salem, North Carolina.Victoria O. Nnadi, M.D.Forsyth Medical Group, Winston-Salem, North Carolina.Daniel A. Belletti, M.A.Novartis Pharmaceuticals Corporation, East Hanover, New Jersey,Jenifer Wogen, M.S.MedMentis Consulting, LLC, Towaco, New Jersey.Steve Arcona, Ph.D.Novartis Pharmaceuticals Corporation, East Hanover, New Jersey,;

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    Implications for Quality Improvement Initiatives;

    机译：对质量改进计划的影响;

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