在美国卫生系统中,与控制不下的高血压治疗强化相关的因素
Jaejin An1,2, Teresa N Harrison3, Liang Ni3
1Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. jaejin.x.an@kp.org.
Journal of general internal medicine
|December 9, 2025
概括
治疗惯性在高血压管理中很常见,只有29%的患者接受治疗强化. 基于团队的BP诊所改善了强化率,突出了加强血压控制的有针对性的干预措施的必要性.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 治疗惯性是有效控制血压 (BP) 的重要障碍,需要对影响治疗强化因素进行调查.
- 失控的高血压仍然是全球主要的健康问题,强调需要优化管理策略.
研究的目的:
- 确定与治疗强化失控高血压相关的人口,临床和卫生系统因素.
- 为了比较个人医疗办公室访问和以团队为基础的BP诊所遭遇之间的治疗强化率.
主要方法:
- 一种混合方法的方法,结合了电子健康记录 (EHR) 的定量分析和来自11个半结构化提供者访谈的定性见解.
- 分析了从2018年起在南加利福尼亚州凯泽永久医院对221,519名患有无控高血压 (血压≥140/90毫米) 的成年患者的EHR数据,并对其进行了6个月的跟踪.
- 治疗强化被定义为增加药物剂量或添加新的抗高血压药物类别;多变量回归确定了相关因素.
主要成果:
- 只有29%的无控制血压患者经历了治疗加剧.
- 年龄较大 (≥76岁) 和糖尿病与治疗加剧的几率较低有关.
- 与标准办公室访问相比,以团队为基础的BP诊所接触表明治疗加剧的几率更高 (OR=1.23).
- 提供者采访显示,对副作用,药物不服药和共享决策的担忧是加强治疗的关键障碍.
结论:
- 不到三分之一的患有失控高血压的患者接受了强化治疗,这表明持续的治疗惯性.
- 基于团队的高血压诊所有助于更频繁的治疗强化,这表明它们有改善高血压管理的潜力.
- 针对特定障碍的有针对性的干预措施对于加强血压控制和降低心血管风险至关重要.
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