Challenges and strategies for hypertension management: qualitative analysis of small primary care practices with varying blood pressure control.
Publication Date
2019
Journal Title
Fam Pract
Abstract
BACKGROUND: Electronic health record (EHR) data on blood pressure (BP) control among patients with hypertension show that practices' rates vary greatly. This suggests providers use different approaches in managing hypertension, and so we aimed to explore challenges small primary care practice providers face and strategies they use to manage patients' BP. We explored differences between providers with high and low BP control rates to help inform future quality improvement work.
METHODS: In 2015, we recruited practices in New York City with five or fewer providers. We employed a stratified purposeful sampling method, using EHR data to categorize small practices into groups based on the proportion of patients with hypertension whose last BP was <140/90: high control (>= 80%), average control (60-80%) and low control (
RESULTS: Small practice providers reported treatment non-adherence as one of the primary challenges in managing patients' hypertension, and described using patient education, relationship building and self-management tools to address this issue. Providers differed qualitatively in the way they described using these strategies; high BP control providers described more actively engaging and listening to patients than low control providers did.
CONCLUSIONS: How providers communicate with patients may impact outcomes-future quality improvement initiatives should consider trainings to improve patient-provider communication.
Volume Number
36
Issue Number
5
Pages
644-649
Document Type
Article
Status
Faculty
Facility
School of Medicine
Primary Department
General Internal Medicine
Additional Departments
Molecular Medicine
PMID
DOI
- 10.1093/fampra/cmz004