Patient and practice perspectives on strategies for controlling blood pressure, North Carolina, 2010-2012.
BACKGROUND
Patient and practice perspectives can inform development of team-based approaches to improving blood pressure control in primary care. We used a community-based participatory research approach to assess patient and practice perceptions regarding the value of team-based strategies for controlling blood pressure in a rural North Carolina population from 2010 through 2012.


METHODS
In-depth interviews were conducted with 41 adults with hypertension, purposely sampled to include diversity of sex, race, literacy, and blood pressure control, and with key office staff at 5 rural primary care practices in the southeastern US "stroke belt." Interviews explored barriers to controlling blood pressure, the practice's role in controlling blood pressure, and opinions on the use of team care delivery.


RESULTS
Patients reported that provider strategies to optimize blood pressure control should include regular visits, medication adjustment, side-effect discussion, and behavioral counseling. When discussing team-based approaches to hypertension care, patients valued verbal encouragement, calls from the doctor's office, and the opportunity to ask questions. However, they voiced concerns about the effect of having too many people involved in their care. Practice staff focused on multiple, broad methods to control blood pressure including counseling, regular office visits, media to improve awareness, and support groups. An explicit focus of delivering care as teams was a newer concept.


CONCLUSIONS
When developing a team approach to hypertension treatment, patients value high-quality communication and not losing their primary relationship with their provider. Practice staff members were open to a team-based approach but had limited knowledge of what such an approach would entail.
University of North Carolina at Chapel Hill, Department of Family Medicine, 590 Manning Dr, Chapel Hill, NC 27599. Email: kdonahue@med.unc.edu.
Katrina E
KE
Donahue
University of North Carolina, Chapel Hill, North Carolina.
Maihan B
MB
Vu
University of North Carolina, Chapel Hill, North Carolina.
Jacqueline R
JR
Halladay
University of North Carolina, Chapel Hill, North Carolina.
Cassandra
C
Miller
University of North Carolina, Chapel Hill, North Carolina.
Beverly A
BA
Garcia
East Carolina University, Greenville, North Carolina.
Doyle M
DM
Cummings
University of North Carolina, Chapel Hill, North Carolina.
Crystal W
CW
Cene
University of North Carolina, Chapel Hill, North Carolina.
Alan
A
Hinderliter
primary care practices in eastern North Carolina.
Edwin
E
Little
primary care practices in eastern North Carolina.
Marjorie
M
Rachide
University of North Carolina, Chapel Hill, North Carolina.
Darren
D
DeWalt
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006266:Health Education; D006282:Health Personnel; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010353:Patient Education as Topic; D057240:Patient Preference; D011314:Preventive Health Services; D011785:Quality Assurance, Health Care
D000959:Antihypertensive Agents