title: Delegating responsibility from clinicians to nonprofessional personnel: the example of hypertension control.
abstract: BACKGROUND
  Involving nonclinician personnel in the treatment of hypertension may provide a solution to improve blood pressure control; however, this team-based approach cannot be implemented without first determining clinicians' willingness to delegate patient care to nonclinician team members. This study explores clinicians' perspectives on working with nonclinicians trained as "health coaches" to address medication adherence and lack of medication intensification among low-income patients with uncontrolled hypertension.
  
  
  METHODS
  We used a qualitative research approach to determine clinicians' opinions on the Treat-to-Target study, an intervention to improve blood pressure control. We conducted focus groups with clinicians who practice family medicine in a safety net clinic. Transcripts were analyzed using thematic content analysis.
  
  
  RESULTS
  Seven overarching themes emerged: (1) Clinicians support the delegation of functions to health coaches; (2) clinicians like the high frequency of coach-patient interactions; (3) clinicians feel that health coaching assists medication adherence; (4) clinicians have varying views on home titration; (5) coach-clinician communication is necessary for successful delegation; (6) coaching helps clinicians understand their patients' barriers to hypertension control; and (7) clinicians would like health coaching to continue on a permanent basis.
  
  
  CONCLUSIONS
  Clinicians appreciate the presence of nonclinicians on the primary care team. In the coming era of primary care clinician shortage, clinicians can be supportive of nonprofessional team members assisting with the care of patients with hypertension.
authors.affiliation: Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA 94110, USA.
authors.forename: David
authors.initials: D
authors.lastname: Margolius
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wong
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Goldman
authors.forename: James
authors.initials: J
authors.lastname: Rouse-Iniguez
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodenheimer
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D033183:Interdisciplinary Communication; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D010353:Patient Education as Topic; D032024:Personnel Delegation; D011320:Primary Health Care; D011787:Quality of Health Care; D012648:Self Care; D013689:Telephone; D016896:Treatment Outcome; D017664:Uncompensated Care
chemical_list: D000959:Antihypertensive Agents