Primary care provider's barriers to effective management of apparently resistant hypertension in Malaysian public primary health care and strategies to overcome them: a qualitative study.

Abstract

BACKGROUND: Managing ARH in public PHC is challenging. This study provides the first in-depth qualitative exploration of barriers to effective ARH management among PCPs, including FMS and MO in Malaysian public PHCs, and of strategies to overcome them. METHODS: This qualitative study involved 7 IDIs with FMS and 7 FGDs with small groups of 3 MOs (total 21 MOs), purposively selected across 7 Malaysian public PHCs from March to July 2024. A reflexive thematic analysis grounded in a constructivist paradigm was conducted. RESULTS: PCPs (FMS and MO) identified barriers at three levels. Theme 1: Patient (Subthemes: poor adherence to medications and follow-up, limited health literacy, inability to afford home BP monitors, culturally driven high-salt diet, lack of family or caregiver support for dependent elderly). Theme 2: Provider (Subthemes: knowledge gaps, diagnostic uncertainty, workload pressures and time constraints, therapeutic hesitancy in complicated cases). Theme 3: Health system (Subthemes: limited diagnostic resources in public PHC, restricted access to FDC antihypertensive medications, vague referral process, limited team-based approach, fragmented care). PCPs (FMS and MO) have employed and proposed strategies to overcome these barriers. Theme 4: Strategies to overcome barriers (Subthemes: engaging family members and caregivers, simplifying out-of-office BP monitoring, optimising clinic appointment scheduling and virtual consultations, establishing multidisciplinary team-based care, professional capacity building, standardising referral algorithms, enhancing patient education materials and programmes, strengthening continuity of care, and improving access to FDC antihypertensive medications). CONCLUSION: Addressing these barriers requires healthcare reform centred on multilevel, context-sensitive interventions. Key steps include standardising education and training for patients, caregivers, and PCPs (FMS and MO); standardising referral algorithms; establishing multidisciplinary team-based care; improving access to FDC antihypertensive medications; optimising clinic appointment scheduling and virtual consultations; and strengthening continuity of care.