title: Providers' assessment of barriers to effective management of hypertension and hyperlipidemia in community health centers.
abstract: We explored 251 providers' (47% licensed practical nurses, 27% registered nurses, 10% physicians, 10% physician assistants, 6% other) perceptions of barriers to effective management of hypertension and hyperlipidemia from 72 Midwest community health centers (CHCs). Optimal care for these diseases is difficult in any setting; little is known about the specific barriers CHCs face. Community health centers often have a multidisciplinary team that participates in patient care. Current models of quality improvement and chronic care management require virtually all CHC providers to know clinical guidelines. Providers in this study generally chose hypertension and hyperlipidemia target levels that met or were more stringent than national guidelines, but lacked confidence to address behavioral change and reported obstacles to modifying patient lifestyle. Community health centers should strengthen providers' skills in facilitating lifestyle change. Improving quality of care requires supporting providers' efforts to take patients' psychosocial and financial challenges into account, and revised policies to eliminate financial and cultural barriers to care.
authors.affiliation: Chicago Diabetes Research and Training Center, USA. scook@uchicago.edu
authors.forename: Sandy
authors.initials: S
authors.lastname: Cook
authors.forename: Melinda L
authors.initials: ML
authors.lastname: Drum
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kirchhoff
authors.forename: Lei
authors.initials: L
authors.lastname: Jin
authors.forename: Jessica
authors.initials: J
authors.lastname: Levie
authors.forename: James F
authors.initials: JF
authors.lastname: Harrison
authors.forename: Susan A
authors.initials: SA
authors.lastname: Lippold
authors.forename: Cynthia T
authors.initials: CT
authors.lastname: Schaefer
authors.forename: Marshall H
authors.initials: MH
authors.lastname: Chin
mesh_terms: D001291:Attitude of Health Personnel; D003151:Community Health Centers; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology / Q000628:therapy*; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D008019:Life Style; D015146:Midwestern United States / Q000453:epidemiology; D010346:Patient Care Management