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HSR&D Citation Abstract

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Patient perspectives on managing hypertension: Developing a new conceptual model of patient behavior

Bokhour BG, Solomon J, Cohn ES, Cortes DE, Elwy AR, Haidet P, Katz L, Borzecki AM, Green A, Kressin NR. Patient perspectives on managing hypertension: Developing a new conceptual model of patient behavior. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2009 May 20; Miami, FL.

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BACKGROUND: With up to 30% of patients having uncontrolled hypertension, finding novel ways to improve upon patients hypertension self-management is a priority. The role of patient perspectives, beliefs and practices in hypertension management remains poorly understood. We sought to develop a more comprehensive conceptual model of patient hypertension management. METHODS: We conducted semi-structured qualitative interviews with 55 white, Latino and African-American patients with uncontrolled hypertension at two large Veterans Affairs Medical Centers. Fully transcribed interviews were analyzed using grounded theory analytic methodology, including open and axial coding, theorizing and constant comparison analysis across cases. Conceptual models were iteratively developed and refined through review of individual cases. RESULTS: We identified four domains which affected the actions patients took to manage their hypertension: 1) Explanatory models - beliefs that individuals have regarding the cause, mechanisms and course of illness, and effects of treatment; 2) Planned action -patients reported plans and motivations to control their hypertension; 3) Daily lived experience - patients context, routines and other health problems that affect hypertension management; and 4) relationship with provider - including patients attitudes towards their provider and provider communication. A breakdown in one of more of these areas were found to interfere with the patients ability to engage in accepted hypertension control behaviors such as watching their diet, exercising, or taking prescribed medications. For example, many patients believed that stress was the primary reason their blood pressure would rise, and thereby their primary actions to control BP were managing stress. Other patients recognized the impact of hypertension and how they could manage it, but their daily lived experiences interfered due to few routines in their lives or social isolation. Patients rarely reported provider discussions about such issues in their clinical encounters. CONCLUSION: In order to improve hypertension control, providers need to address patients understandings of hypertension, their daily lived experience in managing hypertension as well as their motivations for controlling their hypertension. Simply providing information about hypertension and prescribing appropriate medications may be inadequate if other aspects of patients belief systems and daily lived experiences interfere with their ability to follow through on recommendations. The conceptual model we have developed has implications for the ways in which we counsel patients about management of hypertension as well other chronic diseases. Designing interventions which include all aspects that contribute to patients actions to control hypertension may lead to better overall blood pressure control and patient health.

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