The Level And Influencing Factors Of Health Assessment For Hypertensive Patients By Primary Care Physicians

Objective:To compile the Knowledge,Attitude and Practice Scale for Hypertension Health Assessment of Grassroots Doctors and test its reliability and validity.Using this scale,we can understand the knowledge,attitude and behavior of primary doctors on hypertension health assessment,analyze the influencing factors,and provide theoretical basis for subsequent standardized training.Methods:1.Based on Knowledge-Attitude-Practice theory,the initial questionnaire items were constructed by literature retrieval,in-depth interviews with grassroots doctors,and discussion by research groups,and 183 grassroots doctors in Taiyuan were pre-surveyed in April-May,2022.Through discrete trend method,critical ratio method,correlation coefficient method,Cronbach’s alpha coefficient method and factor analysis method,the pre-survey results were screened and and tested for reliability and validity.Thus,the formal scale of knowledge,attitude and behavior of primary doctors for hypertension health assessment was formed.2.From May to June,2022,a multi-stage stratified sampling method was used to conduct an online survey of 420 primary care physicians in northern,central and southern Shanxi Province.The survey included information of their baseline demographics of primary care physicians,the current status of self-assessed KAP for hypertension health assessment,the hindering factors for conducting comprehensive health assessment of hypertensive patients and the availability of hypertension assessment tools in their medical institutions.Descriptive statistical analysis,t-test,variance analysis,Pearson correlation analysis and multiple linear regression analysis were used to explore the current level and influencing factors of hypertension health assessment among primary doctors.Results:1.The initial scale contains 36 items in 3 dimensions,and 33 items are retained after item screening.Exploratory factor analysis extracted a three-factor model,and the cumulative contribution rate was 71.309%.Cronbach’s alpha coefficient of the total scale and the three dimensions of knowledge,attitude and behavior were 0.947～0.973,Spearman-Brown coefficient were 0.868～0.954,and the test-retest reliability were0.812～0.905.2.A total of 402 valid questionnaires were collected,with an effective rate of 97.5%.The total average score of KAP of the primary care physicians on the health assessment for hypertensive patients was(127.16±18.65),with an average score of(53.68±8.95)on the knowledge dimension,(28.62±4.09)on the attitude dimension and(44.86±7.53)on the practice dimension.The results of Pearson correlation analysis showed that the correlation coefficients of knowledge,attitude and behaviour of primary care doctors on hypertension health assessment were all positive.The correlation coefficients of knowledge and attitude,knowledge and behaviour,and attitude and behaviour were 0.556,0.735 and 0.726,respectively,and the differences were statistically significant(P < 0.01).3.The results of multiple linear regression analysis showed that work unit,the level of highest educational attainment,specialty,participation in standardized training,learning the latest National Guidelines for the Management of Primary Hypertension in Primary Care,receiving health management-related training,frequency of learning chronic disease knowledge and skills organized by their medical institutions,and weekly hours of independent learning were associated with the knowledge dimension of hypertension health assessment among primary care physicians(P<0.05).The participation in standardized training,mode of employment,learning the latest National Guidelines for the Management of Primary Hypertension in Primary Care,frequency of learning chronic disease-related knowledge and management skills organized by their medical institutions,and weekly hours of independent learning were factors influencing primary care physicians’ scores on the attitude dimension of hypertension health assessment(P<0.05).Acquisition of physician qualifications,the participation in standardized training,learning the latest National Guidelines for the Management of Primary Hypertension in Primary Care,receiving health management-related training,frequency of learning chronic disease-related knowledge and management skills organized by their medical institutions,and weekly hours of independent learning were factors influencing primary care physicians’ scores on the behavioral dimension of hypertension health assessment(P<0.05).4.Grass roots doctors believe that the main obstacles to the comprehensive health assessment of hypertension patients are insufficient professional knowledge reserves,the impact of the COVID-19,insufficient equipment in their medical institutions,and unskilled use of assessment tools(65.9%、64.2%、62.9%、50.5%,respectively).In terms of the hypertension assessment equipment equipped in the medical institutions of primary care physicians,except for sphygmomanometer,height and weight measuring instruments and soft rulers for measuring waist circumference with a configuration rate of more than 96.8%,the configuration rates of routine hematology analyzers,routine urine chemistry analyzers,blood biochemistry analyzers,electrocardiogram machines,and chest X-ray equipment(35.6%,35.8%,26.9%,42.8%,and 23.1%,respectively)were all less than 45.0%,and the configuration rates of ambulatory blood pressure monitor,cardiac ultrasound machines,vascular color Doppler ultrasound equipment and funduscopic examination equipment were even lower(less than 15.0%).Conclusions:1.The scale developed in this study has good reliability and validity and can be used to assess the Knowledge,Attitude and practice of primary care physicians in assessing hypertension.2.Primary care doctors have a more positive attitude towards hypertension health assessment,but their cognition and practice still need to be improved.Knowledge is a necessary condition for behavior change.We should seize the weak links of theoretical knowledge and practical ability of primary care doctors,strengthen their professional knowledge education and continuing education,strengthen their health assessment ability,and promote knowledge into practice,so as to meet the needs of primary care people in the diagnosis and treatment of hypertension chronic diseases.3.There is a significant positive correlation between knowledge-attitude-practice of primary care physicians on hypertension health assessment.The more knowledgeable they are,the more positive their attitude is and the more willing they are to adequately assess the health status,health risks and health outcomes of hypertensive patients,improving the diagnostic assessment of hypertension and reducing the incidence of missed diagnosis and misdiagnosis.4.The longer the number of hours of independent learning per week,the more training related to health management they have received,the more frequent they have received standardized training,and the more frequently their medical institutions organize learning about chronic disease knowledge and skills,the higher the knowledge,attitude and practice scores of primary care doctors on hypertension health assessment.Standardized training on professional knowledge and skills for primary care staff should be strengthened to stimulate their awareness and ability to learn on their own in order to improve primary health care services and standards.5.Factors that prevent primary care doctors from conducting comprehensive health assessments of hypertensive patients mainly include personal,assessment equipment in their units and the surrounding environment.The overall allocation rate of hypertension assessment equipment equipped in doctors’ medical institutions is low,which is not sufficient for the next step of stratification and grading and differential diagnosis of hypertensive patients,etc.There is a need to supplement the equipment for the treatment of common and multiple diseases in primary health institutions and to improve the incentive and assessment system in primary health institutions.