Abstract
BackgroundTo explore the perception of home blood pressure monitoring (HBPM) by general practitioners (GPs) in everyday practice in order to identify facilitators and barriers to its implementation in daily practice.MethodsA qualitative study comprising the conduct of six focus groups between October 2016 and February 2017, gathering 41 general practitioners in primary care practice in Lorraine (North Eastern France), with thematic and comprehensive analysis.ResultsThe first reasons given by GPs to explain their difficulties with HBPM (Home Blood Pressure Monitoring) implementation were the usual lack of time, material and human resources. However, all of these motives masked other substantial limiting factors including insufficient knowledge regarding HBPM, poor adherence to recommendations on HBPM and fear of losing their medical authority. GPs admitted that HBPM use could enhance patient observance and decrease therapeutic inertia. Despite this observation, most GPs used HBPM only at the time of diagnosis and rarely for follow-up. One explanation for GP reluctance towards HBPM may be, along with guidelines regarding hypertension, HBPM is perceived as being a binding framework and being difficult to implement. This barrier was more predominantly observed among aging GPs than in young GPs and was less frequent when GPs practiced in multidisciplinary health centers because the logistical barrier was no longer present.DiscussionIn order to improve HBPM implementation in everyday practice in France, it is necessary to focus on GP training and patient education. We must also end "medical power" in hypertension management and turn to multidisciplinary care including nurses, pharmacists and patients.
Highlights
Hypertension is the foremost chronic disease in the world
The first reasons given by general practitioner (GP) to explain their difficulties with home blood pressure monitoring (HBPM) (Home Blood Pressure Monitoring) implementation were the usual lack of time, material and human resources
GPs admitted that HBPM use could enhance patient observance and decrease therapeutic inertia
Summary
In 2012, high blood pressure accounted for 30% of individuals over 25 years of age worldwide and a crude increase in the prevalence in the last decade has been observed [1]. Despite recommendations put forward over the past several years to improve its management, hypertension remains insufficiently controlled [3,4]. In Europe, blood pressure (BP) targets are rarely reached, whether patient management is overseen by a general practitioner (GP) or by a specialist [5,6]. In France, 55% of hypertensive patients were adequately controlled in 2015 [7] and only 50.9% in 2017 [2]. To explore the perception of home blood pressure monitoring (HBPM) by general practitioners (GPs) in everyday practice in order to identify facilitators and barriers to its implementation in daily practice
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