Article Text

Original research
Opinions on hypertension care and therapy adherence at the healthcare provider and healthcare system level: a qualitative study in the Hague, Netherlands
  1. Saskia E van Grondelle1,
  2. Sytske van Bruggen1,2,
  3. Judith Meijer1,
  4. Erik van Duin2,
  5. Michiel L Bots3,
  6. Guy Rutten3,
  7. Hedwig M M Vos1,
  8. Mattijs E Numans1,
  9. Rimke C Vos1
  1. 1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Hadoks Chronische zorg BV, Den Haag, The Netherlands
  3. 3Julius Center for Health Sciences and Primary Care, UMC, Utrecht, The Netherlands
  1. Correspondence to Saskia E van Grondelle; s.e.vangrondelle{at}gmail.com

Abstract

Objectives Hypertension is a common cause of cardiovascular morbidity and mortality. Although hypertension can be effectively controlled by blood pressure-lowering drugs, uncontrolled blood pressure is common despite use of these medications. One explanation is therapy non-adherence. Therapy non-adherence can be addressed at the individual level, the level of the healthcare provider and at the healthcare system level. Since the latter two levels are often overlooked, we wished to explore facilitators and barriers on each of these levels in relation to hypertension care for people with hypertension, with a specific focus on therapy adherence.

Design Qualitative study using focus groups of healthcare providers. Data were analysed using the theoretical domains framework (TDF) and the behaviour change wheel.

Setting and participants Participants were from a highly urbanised city environment (the Hague, Netherlands), and included nine primary care physicians, six practice nurses and five secondary care physicians involved in hypertension care.

Results Nine domains on the TDF were found to be relevant at the healthcare provider level (‘knowledge’, ‘physical, cognitive and interpersonal skills’, ‘memory, attention and decision processes’, ‘professional, social role and identity’, ‘optimism’, ‘beliefs about consequences’, ‘intention’, ‘emotion’ and ‘social influences’) and two domains (‘resources’ and ‘goals’) were found to be relevant at the system level. Facilitators for these domains were good interpersonal skills, paying attention to behavioural factors such as medication use, and the belief that treatment improves health outcomes. Barriers were related to time, interdisciplinary collaboration, technical and financial issues, availability of blood pressure devices and education of people with hypertension.

Conclusions This study highlighted a need for better collaboration between primary and secondary care, for more team-based care including pharmacists and social workers, tools to improve interpersonal skills and more time for patient–healthcare provider communication.

  • primary care
  • hypertension
  • qualitative research

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Footnotes

  • Twitter @HedwigVos

  • Contributors SvB and RCV coordinated and collected data by organising the focus groups. SEvG, JM and SvB analysed the data. SEvG wrote the paper. RCV, SvB, EvD, MLB, GR, HMMV and MEN commented on the paper. RCV is responsible for the overall content as the guarantor.

  • Funding This work was funded through an EFSD (European Foundation for the study of Diabetes) award supported by Sorvier. Grant number: N/A.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.