Effect of Health Insurance and Facility Quality Improvement on Blood Pressure in Adults With Hypertension in Nigeria

Abstract

Background: Hypertension is a leading risk factor for death in sub-Saharan Africa. Quality treatment is often not available nor affordable. We assessed the effect of a voluntary health insurance program, including quality improvement of healthcare facilities, on blood pressure (BP) in hypertensive adults in rural Nigeria. Methods: We compared changes in outcomes from baseline (2009) to midline (2011) and endline (2013) between non-pregnant hypertensive adults in the insurance program area (PA) and a control area (CA), through household surveys. The primary outcome was the difference between the PA and CA in change in BP, using difference-in-differences analysis. Results: Of 1500 eligible households, 1450 (96.7%) participated, including 559 (20.8%) hypertensive individuals, of which 332 (59.4%) had follow-up data. Insurance coverage increased from 0% at baseline to 41.8% at endline in the PA and remained under 1% in the CA. The PA showed a 4.97 mm Hg (95% CI: −0.76 to +10.71 mm Hg) greater decrease in systolic BP and a 1.81 mm Hg (−1.06 to +4.68 mm Hg) greater decrease in diastolic BP from baseline to endline compared to the CA. Respondents with stage 2 hypertension showed an 11.43 mm Hg (95% CI: 1.62 to 21.23 mm Hg) greater reduction in systolic BP and 3.15 mm Hg (−1.22 to +7.53 mm Hg) greater reduction in diastolic BP in the PA compared to the CA. Attrition did not affect the results. Conclusion: Access to improved quality healthcare through an insurance program in rural Nigeria was associated with a significant longer-term reduction in systolic BP in subjects with moderate or severe hypertension.

What Can Altmetric.com Tell Us About Policy Citations of Research? An Analysis of Altmetric.com Data for Research Articles from the University of Sheffield

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Racial and Ethnic Differences in Antihypertensive Medication Use and Blood Pressure Control Among US Adults With Hypertension

“…17,18 Some of the important patient-related reasons include awareness and understanding of the disease, 19 adherence to prescribed antihypertensive therapies and lifestyle changes, 20,21 access to medical care including drug affordability 22,23 and biology of the disease. 24 Healthcarerelated reasons include accepted standards and goals in hypertension treatment and control, physician education and familiarity with therapeutic options, antihypertensive regimen complexity, provider-patient interaction, and adequate patient follow-up.…”

How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study

“…Previous research in Nigeria and other countries in SSA has indicated that health system interventions such as health insurance coverage, organizational support to facilities and the training of health professionals can facilitate the access to and delivery of high quality CVD prevention care in primary care settings [8]- [14]. But even if high quality care is available, there is evidence that many patients fail to adhere to the recommended treatment and do not meet their treatment goals [15]- [17].…”

“…A systematic review of studies on various strategies for improving the quality of primary hypertension care in high income countries concludes that organizational health system changes and patient education have the biggest impact on blood pressure (BP) outcomes [26]. Some recent primary care studies from Nigeria also demonstrate that organizational quality improvement interventions can lead to improved clinical outcomes in hypertensive patients [14] [27] [28]. However, to date little information is available about the impact of patient education on hypertension management in low resource communities in Nigeria or other countries in SSA.…”