影响儿童高血压检测的家长需求、建议和系统性挑战。

IF 2.5 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Abbas H. Zaidi, Erica Sood, Sarah De Ferranti, Samuel Gidding, Varsha Zadokar, Jonathan Miller, Anne Kazak
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引用次数: 0

摘要

在美国,儿童高血压(HTN)影响3%-5%的儿童,但只有25%被诊断出来,60%缺乏推荐的随访护理。家长和临床医生对血压(BP)读数升高持怀疑态度,不愿使用抗高血压药物,这突出了利益相关者知情策略的必要性,以应对这些挑战。本研究调查了父母的感知需求、他们建议的改善HTN检测的策略以及相关卫生系统挑战。来自10个儿科初级保健诊所的家长和临床医生参加了半结构化定性访谈。只有记录在案的2期血压读数和HTN诊断,但护理间隔1年或更长时间的孩子的父母被纳入研究。参与者是从不同社区的诊所招募的。专题分析确定了实施研究综合框架指导下的主要主题和建议。共有38名利益相关者参与,其中包括13名家长和25名保健临床医生。家长们报告说,在诊所里关于儿科HTN的讨论有限,与健康的社会决定因素相关的后勤障碍,包括经济负担和保险问题,以及时间冲突。临床医生列举了系统限制,如时间限制、人员短缺和资源不足,以解决与健康相关需求的社会决定因素。家长推荐的策略包括加强儿科HTN教育、灵活安排时间、远程医疗、远程血压监测和改善护理协调,以克服障碍并与系统改进保持一致。家长推荐的策略可以解决儿童HTN检测的挑战。然而,将这些战略与系统约束相结合,对于在HTN检测中有效地、告知利益相关者的改进至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Parent Needs, Recommendations, and Systemic Challenges Affecting Pediatric Hypertension Detection

Parent Needs, Recommendations, and Systemic Challenges Affecting Pediatric Hypertension Detection

Pediatric hypertension (HTN) affects 3%–5% of children in the United States, yet only 25% are diagnosed and 60% lack recommended follow-up care. Skepticism about elevated blood pressure (BP) readings and reluctance to use antihypertensive medications by parents and clinicians highlight the need for stakeholder-informed strategies to address these challenges. This study examined parents’ perceived needs, their recommended strategies to improve HTN detection, and contextual health system challenges. Parents and clinicians from 10 pediatric primary care clinics participated in semi-structured qualitative interviews. Only parents of children with documented stage 2 BP readings and a HTN diagnosis, but with gaps in care of 1 year or longer, were included. Participants were recruited from clinics in diverse communities. Thematic analysis identified major themes and recommendations guided by the Consolidated Framework for Implementation Research (CFIR). A total of 38 stakeholders participated, including 13 parents and 25 healthcare clinicians. Parents reported limited discussions in the clinic around pediatric HTN, logistical barriers related to social determinants of health, including financial burdens and insurance issues, and scheduling conflicts. Clinicians cited systemic constraints such as time limitations, staffing shortages, and insufficient resources to address social determinants of health-related needs. Parents recommended strategies, including enhanced education on pediatric HTN, flexible scheduling, telehealth, remote BP monitoring, and improved care coordination, to overcome barriers and align with systemic improvements. Parent-recommended strategies can address pediatric HTN detection challenges. However, aligning these strategies with systemic constraints is essential for effective, stakeholder-informed improvements in HTN detection.

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来源期刊
Journal of Clinical Hypertension
Journal of Clinical Hypertension PERIPHERAL VASCULAR DISEASE-
CiteScore
5.80
自引率
7.10%
发文量
191
审稿时长
4-8 weeks
期刊介绍: The Journal of Clinical Hypertension is a peer-reviewed, monthly publication that serves internists, cardiologists, nephrologists, endocrinologists, hypertension specialists, primary care practitioners, pharmacists and all professionals interested in hypertension by providing objective, up-to-date information and practical recommendations on the full range of clinical aspects of hypertension. Commentaries and columns by experts in the field provide further insights into our original research articles as well as on major articles published elsewhere. Major guidelines for the management of hypertension are also an important feature of the Journal. Through its partnership with the World Hypertension League, JCH will include a new focus on hypertension and public health, including major policy issues, that features research and reviews related to disease characteristics and management at the population level.
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