Project Summary
Background: 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.
Results: The 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.
Discussion: In 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.
Data Generation
Procedure: Data for this project were generated by a 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. Each meeting was recorded and subsequently fully transcribed to gather all statements. Each focus group was composed of GPs using HBPM more or less regularly. Focus groups were led by a moderator and an observer (GD, LD). The observer’s role was to collect non-verbal behavior, noting silences and hesitations. The role of the moderator was to ensure that each of the GPs could speak on each theme. It was not a questionnaire but a semi-structured open discussion. The duration of the focus groups was about two hours.
Recruitment: Sampling was carried out among a population of general practitioners working in a primary care office setting. Variability in age, gender, type and place of practice were taken into consideration for constituting the different GP panels. The first group comprised teachers and GPs trained in the use of HBPM (some GPs had a university degree in hypertension and cardiovascular risk). The second group comprised GPs occasionaly working with one of the authors and known to them as non-user.
Consent: All participating GPs gave their agreement to the recording of the interviews. All of the comments expressed during each focus group were meticulously transcribed, preserving the anonymity of those involved. All participants were informed regarding the goal of this study, the modalities of focus group attainment and the processing of collected data.
