Psychosocial Considerations in Hypertension Management

This video segment shows the follow up visit with Mary Johnson.

Patient Attitudes

Narrated Slideshow of Patient Attitudes and Adherence

  • Patient attitudes towards clinicians and medicine are greatly influenced by cultural differences, beliefs, and previous experiences with health care system.
  • Attitudes must be understood if the clinician wants to build trust and increase communication with patient and families.
  • It is important to understand how a patient explains the cause of their hypertensive disease, how they believe it can be managed and treated, and how they stay healthy. Their explanatory model may overlap with the clinician’s medical explanatory model, or may be completely different.
    • What do you think caused your problem? What do you call it?
    • Why do you think it started when it did?
    • How does it affect your life?
    • How severe is it? What worries you the most?
    • What kind of treatment do you think would work?
    • How can the doctor be most helpful to you?
    • What is most important for you?
    • Have you seen anyone else about this problem? Other physicians? Anyone else besides a physician?
    • Have you used non-medical remedies or treatments for your problem?
    • Who advises you about your health?

This information is not to correct the patient’s views, but to understand their beliefs and priorities, and to partner with them in their care.

Patient Adherence

  • Increased patient non-adherence is caused by misunderstanding the condition or treatment
  • Perception that “drugs” are symbol of ill health
  • Unexpected adverse effects of medications can occur. A sensitive doctor should try to make patient feel comfortable to bring up any concerns.
  • Denial of illness because of lack of symptoms
  • Lack of patient involvement in care plan
“It’s very important that you explain BP Meds to a patient properly”

Video example of explaining to patients how BP meds work

Social Barriers to Hypertension Care

Narrated Slideshow of Social Barriers to Care & Using All Your Resources

  • The cost of medications
  • Lack of access to care
  • Patient difficulty with polypharmacy
  • Life’s competing demands
  • Transportation issues
  • Difficulty scheduling appointments

Using All Your Resources

  • Although a positive physician – patient relationship is vital in caring for people with hypertension, it is important for clinicians to understand the importance of the role of ancillary staff and community resources.
  • Front desk clerical staff and medical assistants can provide patients a welcoming “medical home”. Nurses and nutritionists can provide extensive counseling and education for patients. Social workers can help address patient financial concerns, entitlement issues, provide emotional individual and family counseling. Resources also include neighborhood pharmacists for answering patient questions; community centers may hold nutrition and exercise classes or support groups. Clinicians can also provide patients with reliable internet resources if appropriate.
  • Physicians should seek culturally responsive resources for their patients whenever possible.

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