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Exploring the Challenges Faced by Primary Care Physicians in Providing Optimal Care for Patients With Hypertension: A
Prawira Oka1,2, Aminath Shiwaza Moosa1,2, Chirk Jenn Ng1,2
1SingHealth Polyclinics, Singapore, Singapore.
Insights
Primary care physicians face new challenges in hypertension management, including patient preferences for alternative remedies and inconvenient blood tests. Optimizing electronic medical records and physician training are key to improving blood pressure control.
Area of Science:
- Primary Care
- Hypertension Management
- Qualitative Research
Background:
- Suboptimal blood pressure control affects most hypertensive patients globally.
- Primary care physicians (PCPs) encounter numerous barriers to effective hypertension care.
Purpose of the Study:
- To explore challenges PCPs face in providing optimal hypertension care.
- To identify novel barriers in hypertension management.
Main Methods:
- Qualitative study involving 17 PCPs from 5 primary care clinics in Singapore.
- Individual in-depth interviews using a topic guide.
- Thematic analysis of transcribed interview data.
Main Results:
- Identified new barriers across patient, physician, drug, and system factors.
- Patient factors: preference for natural remedies, inconvenience of blood tests.
- Physician factors: diagnosing varied BP phenotypes and variability; Drug factors: initiating dual therapy; System factors: suboptimal electronic medical records (EMR).
Conclusions:
- A multi-pronged approach is needed to overcome hypertension care barriers.
- Empower patients through education and reduce medication titration inconvenience.
- Enhance physician training for complex BP phenotypes and optimize EMR systems.
Background:
Globally, most patients with hypertension have suboptimal blood pressure (BP) control. Multiple barriers prevent primary care physicians (PCPs) from effectively caring for these patients. This study aimed to explore the challenges faced by PCPs in providing optimal care for patients with hypertension, with a specific focus on identifying new barriers.
Methods:
This qualitative study involved 17 PCPs across 5 primary care clinics in Singapore. A trained researcher conducted individual in-depth interviews using a topic guide. Purposive sampling was employed to ensure adequate representation of seniority until data saturation was achieved. The audio-recorded interviews were transcribed verbatim and independently checked. The data were managed using NVivo and thematic analysis was conducted.
Results:
New barriers were divided into patient, physician, drug, and systemrelated factors. Patient factors included a preference for natural health remedies and the inconvenience of blood tests. Meanwhile, physicians faced challenges diagnosing and treating patients with various BP phenotypes and BP variability. The initiation of dual therapy was a drugrelated barrier. Finally, system factors included the suboptimal layout of the electronic medical records (EMR) that impeded effective hypertension management.
Conclusion:
A multi-pronged approach is required to address the significant barriers to providing optimal hypertension care. Patients should be empowered through education and minimizing the inconvenience of medication titrations. Additionally, physicians should be better equipped to diagnose and treat patients with more challenging BP phenotypes. Finally, improved access to combination pills and an optimized EMR would contribute to improved care for patients with hypertension.
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