PDF(Pubmed)
Abstract：
Background: Hypertension continues to pose a significant burden on the health systems in Sub-Saharan Africa (SSA). Multiple challenges at the health systems level could impact patients\' blood pressure outcomes. There is a need to understand the gaps in health systems to improve their readiness to manage the rising burden of hypertension Objective: To explore health system barriers and opportunities for improved management of hypertension in Ghana, West Africa. Methods: We conducted 5 focus group discussions involving 9 health facility leaders and 24 clinicians involved in hypertension treatment at 15 primary-level health facilities in Kumasi, Ghana. We held discussions remotely over Zoom and used thematic analysis methods. Results: Four themes emerged from the focus group discussions: (1) financial and geographic inaccessibility of hypertension services; (2) facilities\' struggle to maintain the supply of antihypertensive medications and providers\' perceptions of suboptimal quality of insured medications; (3) shortage of healthcare providers, especially physicians; and (4) patients\' negative self-management practices. Facilitators identified included presence of wellness and hypertension clinics for screening and management of hypertension at some health facilities, nurses\' request for additional roles in hypertension management, and the rising positive practice of patient home blood pressure monitoring. Conclusion: Our findings highlight critical barriers to hypertension service delivery and providers\' abilities to provide quality services. Health facilities should build on ongoing innovations in hypertension screening, task-shifting strategies, and patient self-management to improve hypertension control. In Ghana and other countries, policies to equip healthcare systems with the resources needed for hypertension management could lead to a high improvement in hypertension outcomes among patients.
摘要：
背景：高血压继续对撒哈拉以南非洲（SSA）的卫生系统构成重大负担。卫生系统层面的多重挑战可能会影响患者的血压结果。有必要了解卫生系统的差距，以提高他们的准备，以管理不断上升的高血压负担。西非。方法：我们在库马西的15个基层医疗机构进行了5次焦点小组讨论，涉及9个医疗机构负责人和24名临床医生参与高血压治疗。加纳。我们通过Zoom进行了远程讨论，并使用了主题分析方法。结果：焦点小组讨论中出现了四个主题：（1）高血压服务的财务和地理上的不可及性；（2）设施\“努力维持抗高血压药物的供应和提供者\”对被保险药物质量欠佳的看法；（3）医疗保健提供者短缺，特别是医生；和（4）患者消极的自我管理行为。确定的促进者包括在一些医疗机构开设健康和高血压诊所，以筛查和管理高血压，护士要求在高血压管理中扮演额外的角色，以及病人家庭血压监测的日益积极的做法。结论：我们的发现强调了高血压服务提供和提供者提供优质服务的能力的关键障碍。卫生设施应建立在高血压筛查的持续创新基础上，任务转移策略，和患者自我管理，以提高高血压控制。在加纳和其他国家，为医疗保健系统配备高血压管理所需资源的政策可能导致患者高血压结局的大幅改善.
