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Clinicians' and Patients' Perspectives on Hypertension Care in a Racially and Ethnically Diverse Population in
Julie C Lauffenburger1,2, Renee A Barlev1,2,3, Rasha Khatib4
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Hypertension control is suboptimal for minority patients. Both patients and primary care providers (PCPs) desire more focus on lifestyle changes and improved health information technology (HIT) for better blood pressure management.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Qualitative Health Research
Background:
- Hypertension control remains a significant challenge, particularly among Black and Hispanic or Latino populations.
- Effective strategies are needed to improve hypertension management quality in primary care for at-risk groups.
- Few studies explore primary care provider (PCP) and patient perspectives on blood pressure management.
Purpose of the Study:
- To examine clinician and patient perspectives on barriers and facilitators to hypertension control.
- To understand experiences within a racially and ethnically diverse healthcare system.
- To identify areas for improving hypertension care for diverse populations.
Main Methods:
- Qualitative study using semistructured interviews with 15 patients and 15 clinicians (PCPs and a medical assistant).
- Conducted in a large urban US healthcare system from October 2020 to March 2021.
- Data analyzed using immersion-crystallization methods to identify meaningful patterns.
Main Results:
- Five key themes emerged: challenges in self-management (lifestyle), hesitancy in medication intensification, variable follow-up care, inconsistent blood pressure self-monitoring, and limitations of current health information technology (HIT).
- Most patients (73%) had suboptimally controlled blood pressure.
- Significant variation in hypertension care experiences was reported, even within the same system.
Conclusions:
- Participants emphasized a greater focus on lifestyle modifications over medication for hypertension, especially for minority patients.
- Concerns were raised regarding HIT functionality for asynchronous hypertension care.
- Improved strategies for treatment intensification, self-care, and follow-up are essential for diverse populations.
Importance:
Hypertension control remains suboptimal, particularly for Black and Hispanic or Latino patients. A need exists to improve hypertension management and design effective strategies to efficiently improve the quality of care in primary care, especially for these at-risk populations. Few studies have specifically explored perspectives on blood pressure management by primary care providers (PCPs) and patients.
Objective:
To examine clinician and patient perspectives on barriers and facilitators to hypertension control within a racially and ethnically diverse health care system.
Design, Setting, And Participants:
This qualitative study was conducted in a large urban US health care system from October 1, 2020, to March 31, 2021, among patients with a diagnosis of hypertension from a racially and ethnically diverse population, for a range of hypertension medication use hypertension control, as well as practicing PCPs. Analysis was conducted between June 2021 and February 2022 using immersion-crystallization methods.
Main Outcomes And Measures:
Perspectives on managing blood pressure, including medication adherence and lifestyle, considerations for intensification, and experiences and gaps in using health information technology tools for hypertension, were explored using semistructured qualitative interviews. These cycles of review were continued until all data were examined and meaningful patterns were identified.
Results:
Interviews were conducted with 30 participants: 15 patients (mean [SD] age, 58.6 [16.2] years; 10 women [67%] and 9 Black patients [60%]) and 15 clinicians (14 PCPs and 1 medical assistant; 8 women [53%]). Eleven patients (73%) had suboptimally controlled blood pressure. Participants reported a wide range of experiences with hypertension care, even within the same clinics and health care system. Five themes relevant to managing hypertension for racially and ethnically diverse patient populations in primary care were identified: (1) difficulty with self-management activities, especially lifestyle modifications; (2) hesitancy intensifying medications by both clinicians and patients; (3) varying the timing and follow-up after changes in medication; (4) variation in blood pressure self-monitoring recommendations and uptake; and (5) limited specific functionality of current health information technology tools.
Conclusions And Relevance:
In this qualitative study of the views of PCPs and patients on hypertension control, the participants felt that more focus should be placed on lifestyle modifications than medications for hypertension, particularly for patients from racial and ethnic minority groups. Participants also expressed concerns about the existing functionality of health information technology tools to support increasingly asynchronous hypertension care. More intentional ways of supporting treatment intensification, self-care, and follow-up care are needed to improve hypertension management for racially and ethnically diverse populations in primary care.
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