Organizational Determinants to Hypertension Management: Adapting a Health Equity Framework to Examine Processes at...

Area of Science:

• Primary Care Research
• Health Services Research
• Clinical Management

Background:

• Hypertension control remains a national priority with suboptimal rates.
• Significant variations in hypertension control exist across clinics, even within the same health system.

Purpose of the Study:

• To identify organizational barriers and facilitators impacting hypertension management.
• To explore these factors at provider, clinic, and health system levels.

Main Methods:

• Semi-structured interviews with 25 providers and 22 patients with uncontrolled hypertension.
• Recruitment from 13 primary care clinics across two health systems.
• Analysis using inductive and deductive coding, guided by a health equity framework and thematic analysis.

Main Results:

• Centralization of resources presented both benefits (access) and drawbacks (staffing reductions).
• Barriers included insufficient staffing, inadequate BP equipment, limited rooms, short appointments, and hurried environments.
• Uncompensated work (telemonitoring, correspondence) contributed to provider stress and burnout.

Conclusions:

• Primary care clinics face interconnected organizational challenges in hypertension management.
• Future research should investigate staffing models, telemedicine, and remote BP monitoring for improved outcomes.