Barriers to Access to Treatment for Hypertensive Patients in Primary Health Care of Less Developed Northwest China: A Predictive Nomogram

Abstract

Background. This study aims to evaluate the risk factors associated with untreated hypertension and develop and internally validate untreated risk nomograms in patients with hypertension among primary health care of less developed Northwest China. Methods. A total of 895 eligible patients with hypertension in primary health care of less developed Northwest China were divided into a training set (n = 626) and a validation set (n = 269). Untreated hypertension was defined as not taking antihypertensive medication during the past two weeks. Using least absolute shrinkage and selection operator (LASSO) regression model, we identified the optimized risk factors of nontreatment, followed by establishment of a prediction nomogram. The discriminative ability, calibration, and clinical usefulness were determined using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision analysis. The results were assessed by internal validation in the validation set. Results. Five independent risk factors were derived from LASSO regression model and entered into the nomogram: age, herdsman, family income per member, altitude of habitation, and comorbidity. The nomogram displayed a robust discrimination with an AUC of 0.859 (95% confidence interval: 0.812–0.906) and good calibration. The nomogram was clinically useful when the intervention was decided at the untreated possibility threshold of 7% to 91% in the decision curve analysis. Results were confirmed by internal validation. Conclusions. Our nomogram showed favorable predictive accuracy for untreated hypertension in primary health care of less developed Northwest China and might help primary health care assess the risk of nontreatment in patients with hypertension.

Blood pressure and the hypertension care cascade in The Gambia: Findings from a nationwide survey

“…There should be more localized data to understand determinants of and barriers to treatment uptake to adapt public health interventions to the local context. As reported elsewhere, these factors include patients being worried about the need to take medication for life, perceived side effects of drugs, loss to follow‐up, and inadequate counselling from physician at the time of diagnosis 38–41 . Our study also highlights the need to identify factors leading to non‐treatment of patients with hypertension.…”

“…As reported elsewhere, these factors include patients being worried about the need to take medication for life, perceived side effects of drugs, loss to follow‐up, and inadequate counselling from physician at the time of diagnosis. 38 , 39 , 40 , 41 Our study also highlights the need to identify factors leading to non‐treatment of patients with hypertension. A lot of patients rely on traditional treatment methods whose effect has not been evaluated.…”