我们试图了解影响全科医生(GP)筛查高血压患者原发性醛固酮增多症(PA)的经验的因素。
定性研究,以现象学为框架,使用有音频记录的半结构化访谈,逐字转录,进入NVivoV.12.0进行编码,并针对新兴主题进行分析。
墨尔本,澳大利亚。
作为先前研究的一部分,符合条件的全科医生接受了PA教育。我们招募了16名全科医生(6名女性,10名男性)在练习地点不同,临床经验和PA筛查患者数量。
虽然全科医生接受过关于PA的教育,他们发现向患者解释病情具有挑战性,并且不确定如何筛查已经服用抗高血压药物的患者。大多数人认为筛选过程是实用的,便宜,总的来说,接受他们的病人。然而,他们发现,在筛查前改变抗高血压药物,以便更容易地解释醛固酮-肾素比值是不方便的.他们对筛查他们认为符合原发性高血压临床表现的患者也不太热情。了解筛选过程,执行醛固酮-肾素比率的成本和便利性,与PA相关的风险概念化,改善临床护理的愿望是改变全科医生筛查经验的影响因素。
我们的研究结果表明,知识差距,醛固酮-肾素比率的实际局限性,诊断推理中的错误是常规PA筛查的挑战.这些实际障碍中的大多数可以通过相对简单的教育和实践修改来解决,以提高PA筛查率并优化对初级保健中继发性高血压最常见原因的检测。
We sought to understand the factors that influence a general practitioner\'s (GP\'s) experience of screening for primary aldosteronism (PA) in hypertensive patients.
A qualitative
study, framed by phenomenology, using semistructured interviews that were audiorecorded, transcribed verbatim, entered into NVivo V.12.0 for coding and analysed for emerging themes.
Melbourne, Australia.
Eligible GPs had received education on PA as part of a previous
study. We recruited a purposive sample of 16 GPs (6 females, 10 males) who varied in practice location, clinical experience and the number of patients screened for PA.
Although GPs had been educated about PA, they found it challenging to explain the condition to patients and were uncertain about how to screen patients who were already taking antihypertensive medications. Most viewed the screening process to be practical, inexpensive and, by and large, acceptable to their patients. However, they found it inconvenient to alter antihypertensive medications before screening to allow for easier interpretation of the aldosterone-renin ratio. They were also less enthused about screening patients whom they thought fitted a clinical picture of essential hypertension. Knowledge of the screening process, cost and convenience of performing the aldosterone-renin ratio, conceptualisation of risk related to PA, and a desire to improve clinical care were influencing factors that modified the GPs\' screening experience.
Our findings suggest that knowledge gaps, practical limitations of the aldosterone-renin ratio, and errors in diagnostic reasoning were challenges of routine PA screening. Most of these practical barriers could be addressed by relatively simple educational and practice modifications to increase PA screening rates and optimise detection for the most common cause of secondary hypertension in primary care.