Health system barriers to hypertension care in Peru: Rapid assessment to inform organizational-level change.

Autor:	Williams KN; Department of International Health, Social and Behavioral Interventions Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America., Tenorio-Mucha J; Facultad de Salud Publica y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru., Campos-Blanco K; Facultad de Salud Publica y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru.; Centro Latinoamericano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru., Underhill LJ; Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America., Valdés-Velásquez A; Centro Latinoamericano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru.; Laboratorio de Estudios en Sistemas Socio-Ecológicos, Universidad Peruana Cayetano Heredia, Lima, Peru., Herbozo AF; Facultad de Salud Publica y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru., Beres LK; Department of International Health, Social and Behavioral Interventions Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America., de las Fuentes L; Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America., Cordova-Ascona L; Facultad de Salud Publica y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru.; Centro Latinoamericano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru., Vela-Clavo Z; Facultad de Salud Publica y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru.; Centro Latinoamericano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru., Cuentas-Canal GM; Departamento de Medicina, Servicio de Medicina, Hospital Base III EsSalud, Puno, Peru., Mendoza-Velasquez JC; Direccion Regional de Salud (DIRESA; Regional Health Ministry), Puno, Peru., Paredes-Barriga SM; Direccion Regional de Salud (DIRESA; Regional Health Ministry), Puno, Peru., Hurtado La Rosa R; Dirección de Prevención y Control de Enfermedades No Transmisibles (Directorate of Prevention and Control of Non-Communicable Diseases), Ministerio de Salud (MINSA; Ministry of Health), Lima, Peru., Williams M; Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America., Geng EH; Center for Dissemination and Implementation, Institute for Public Health, and Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America., Checkley W; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America., Gittelsohn J; Department of International Health, Social and Behavioral Interventions Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America., Davila-Roman VG; Global Health Center, Institute for Public Health and Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America., Hartinger-Peña SM; Facultad de Salud Publica y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru.; Centro Latinoamericano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Aug 19; Vol. 4 (8), pp. e0002404. Date of Electronic Publication: 2024 Aug 19 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0002404
Abstrakt:	Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru. A participatory stakeholder workshop (October 2021) and 21 in-depth interviews (October 2021-March 2022) were conducted with 55 healthcare professionals (i.e., doctors, nurses, midwives, dentists, nutritionists), followed by a deductive qualitative analysis of transcripts and notes. Participating healthcare providers indicated that low prioritization and lack of national policies for hypertension care have resulted in limited funding and lack of societal-level prevention efforts. Additionally, limited cultural consideration, both in national guidelines as well as by some providers in Puno, results in inadequate care that may not align with local traditions. Providers highlighted that patient care is also hampered by inadequate distribution and occasional shortages of medications and equipment, as well as a lack of personnel and limited opportunities for training in hypertension. Multiple incompatible health information systems, complicated referral systems, and geographic barriers additionally hinder continuity of care and care seeking. Insights gained from health providers on the healthcare system in Puno provide essential contextual information to inform development of organizational-level strategies necessary to improve provider and patient behaviors to achieve better hypertension care outcomes. Competing Interests: The authors have declared that no competing interests exist. (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
Databáze:	MEDLINE
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