Physician perceived barriers and facilitators for self-measured blood pressure monitoring- a qualitative study.

Improving hypertension management is a national priority that can decrease morbidity and mortality. Evidence-based hypertension management guidelines advocate self-measured BP (SMBP), but widespread implementation of SMBP is lacking. The purpose of this study was to describe the perspective of primary care physicians (PCPs) on SMBP to identify the barriers and facilitators for implementing SMBP. We collected data from PCPs from a large health system using semi-structured interviews based on the Theoretical Domains Framework (TDF). Responses were recorded, transcribed, and qualitatively analyzed into three overarching TDF domains based on the Behavior Change Wheel (BCW): 1) Motivation 2) Opportunity and 3) Capabilities. The sample size was based on theme saturation. All 17 participating PCPs believed that SMBP is a useful, but underutilized tool. Although individual practices varied, most physicians felt that the increased data points from SMBP allowed for better hypertension management. Most felt that overcoming existing barriers would be difficult, but identified several facilitators: physician support of SMBP, the possibility of having other trained health professionals to assist with SMBP and patient education; improving patient engagement and empowerment with SMBP, and the interest of the health system in using technology to improve hypertension management. PCPs believe that SMBP can improve hypertension management. There are numerous barriers and facilitators for implementing SMBP. Successful implementation in clinical practice will require implementation strategies targeted at increasing patient acceptability and reducing physician workload. This may need a radical change in the current methods of managing hypertension.

改善高血压管理是一项国家优先事项，能够降低发病率和死亡率。基于证据的高血压管理指南提倡自测血压（SMBP），但SMBP并未得到广泛实施。本研究的目的是描述初级保健医生（PCPs）对SMBP的看法，以确定实施SMBP的障碍和促进因素。 我们基于理论域框架（TDF），通过半结构化访谈从一个大型医疗系统的初级保健医生那里收集数据。对回答进行记录、转录，并根据行为改变轮（BCW）在三个总体TDF域中进行定性分析：1）动机；2）机会；3）能力。样本量基于主题饱和。 所有17名参与的初级保健医生都认为SMBP是一种有用但未得到充分利用的工具。尽管个体做法有所不同，但大多数医生认为SMBP增加的数据点有助于更好地管理高血压。大多数人认为克服现有障碍会很困难，但也确定了几个促进因素：医生对SMBP的支持、有其他经过培训的卫生专业人员协助SMBP和患者教育的可能性；提高患者对SMBP的参与度和自主权，以及医疗系统对利用技术改善高血压管理的兴趣。 初级保健医生认为SMBP能够改善高血压管理。实施SMBP存在众多障碍和促进因素。在临床实践中成功实施将需要针对提高患者接受度和减轻医生工作量的实施策略。这可能需要对当前的高血压管理方法进行彻底变革。