Factors Associated with Appointment Non-Adherence among African-Americans with Severe, Poorly Controlled Hypertension

Nwabuo, Chike C.; Dy, Sydney M.; Weeks, Kristina; Young, J. Hunter

doi:10.1371/journal.pone.0103090

Cited by 51 publications

(80 citation statements)

References 35 publications

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“…Regarding race, Whites in our study had higher ER visit and hospitalization rates but Blacks and Others were more likely to miss their appointments. This is similar to one study describing appointment nonadherence in a cohort of African American patients with poorly controlled hypertension [27]. Reasons for missed appointments in these patients included access to care as well as poorer knowledge and attitudes towards care [27].…”

Section: Adherence By Race and Gendersupporting

confidence: 81%

“…This is similar to one study describing appointment nonadherence in a cohort of African American patients with poorly controlled hypertension [27]. Reasons for missed appointments in these patients included access to care as well as poorer knowledge and attitudes towards care [27]. Although Whites had higher ER visit and hospitalization rates [24], this may be due to the group's ability to recognize symptoms and seek out immediate care [9].…”

Section: Adherence By Race and Gendersupporting

confidence: 72%

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Self-management practices of smokers with asthma and/or chronic obstructive pulmonary disease: a cross-sectional survey

et al. 2017

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Background: Adherence to self-management recommendations is critical for patients with chronic disease. Compared to nonsmokers, smokers with conditions such as diabetes, HIV, and heart disease are less likely to adhere to provider recommendations. Regarding lung disease, asthma and COPD can be caused and/or exacerbated by smoking, however little is known on the relationship between adherence and smoking status in these patients. The purpose of this study was to characterize the relationship between smoking status and adherence to multiple measures of self-care-including medication taking, medication filling, appointment keeping, yearly vaccinations, carrying medical supplies, and healthcare utilization-in patients with asthma and/or COPD. In addition to smoking status, we also included an examination of these measures by race/ethnicity, gender, and diagnosis. Methods: This study employed a cross-sectional design on a convenience sample of n = 84 patients (40-64 years old) with a diagnosis of asthma and/or COPD. The study was conducted between November 2015 and February 2016 in the waiting rooms of the outpatient pulmonary clinics at the University Medical Center of New Orleans. Patients completed surveys while awaiting their clinic appointments. Smoking status, gender, race, and diagnosis were explored as predictors of adherence using descriptive statistics, chi square, and regression analyses. Results: Compared to nonsmokers, smokers were less adherent to medication filling (p < 0.0001), medication taking (p = 0.04), and having yearly vaccinations than nonsmokers (p = 0.003). Independent of smoking status, differences across self-care measures were also found based on respondent diagnosis, race, and gender. Conclusion: Smoking was associated with lower levels of adherence across multiple measures of self-care. By identifying self-management practices that are most difficult for smokers to follow, researchers can develop interventions that target these behaviors. Future studies should further this research by exploring reasons for poor adherence in smokers as well as address barriers that inhibit self-care.

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Section: Adherence By Race and Gendersupporting

confidence: 81%

Section: Adherence By Race and Gendersupporting

confidence: 72%

Self-management practices of smokers with asthma and/or chronic obstructive pulmonary disease: a cross-sectional survey

et al. 2017

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“…It is considered that the lack of hypertension control association with the vast majority of questions in Table 2 should not be considered in the evaluation of hypertensive patients. There was significant degree of agreement as a complicating factor for treatment with important issues in drug area, such as forgetting to take medication and complex schedules, results found in other studies (12)(13) . Accordingly, the fixed drug combination is a strategy that increases the adherence (14) .…”

Section: Discussionsupporting

confidence: 62%

Chronic and asymptomatic diseases influence the control of hypertension treatment in primary care

Pierin

Silva

Colósimo

et al. 2016

Rev. esc. enferm. USP

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Objective:To identify the association between blood pressure control and the following variables: a) bio-social and lifestyle characteristics of hypertensive patients; and b) factors related to the antihypertensive treatment. Methods: This is an exploratory study with 290 people with hypertension from primary care. We used a specific instrument, selfadministered, with 21 questions on factors that can hinder treatment, divided into four dimensions: medication, socioeconomic, institutional and personal beliefs. We adopted a significance level of p <0.05. Results: The control of blood pressure was associated (p <0.05) with female gender, Caucasian ethnicity, primary/secondary education, not drinking alcohol, higher income and regular physical activity. Regarding the factors that can hinder treatment, there was association of hypertension control with only two questions: "feel nothing" and "have to do treatment for life". Conclusion: Sociodemographic variables and beliefs concerning the absence of symptoms and chronicity of the disease influenced the control of hypertension and should be considered in the adherence process to the treatment. DESCRIPTORSHypertension; Medication Adherence; Therapeutics; Life Style; Public Health Nursing. Chronic and asymptomatic diseases influence the control of hypertension treatment in primary careCronicidade e doença assintomática influenciam o controle dos hipertensos em tratamento na atenção básica Cronicidad y enfermedad asintomática influencian el control de los hipertensos en tratamiento en la atención básica

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“…[31][32][33] This factor is not limited to LMICs; lack of health insurance, lack of medication 309 Naanyu et al: Barriers Influencing Linkage to Hypertension Care JGIM coverage, and higher costs are strong predictors of missing appointments among hypertensive patients in the United States. 27,34 In addition, poor adherence to antihypertensive medications has been associated with unaffordable drug prices. 35 Thus, it is not surprising that a lack of finances would feature prominently as a structural barrier in this setting, where the average income for a substantial proportion of the population is less than one US dollar per day.…”

Section: Discussionmentioning

confidence: 99%

“…Such perceived lack of benefit has been shown to be associated with appointment nonadherence in the United States. 27 Inadequate information about hypertension in this region may partially explain this impression of the ineffectiveness of conventional allopathic care. Similar limited knowledge regarding the causes and control of hypertension has been noted in other parts of Kenya, and merits further attention.…”

mentioning

confidence: 99%

Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study

et al. 2016

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BACKGROUND: Hypertension, the leading global risk factor for mortality, is characterized by low treatment and control rates in low-and middle-income countries. Poor linkage to hypertension care contributes to poor outcomes for patients. However, specific factors influencing linkage to hypertension care are not well known. OBJECTIVE: To evaluate factors influencing linkage to hypertension care in rural western Kenya. DESIGN: Qualitative research study using a modified Health Belief Model that incorporates the impact of emotional and environmental factors on behavior. PARTICIPANTS: Mabaraza (traditional community assembly) participants (n=242) responded to an open invitation to residents in their respective communities. Focus groups, formed by purposive sampling, consisted of hypertensive individuals, at-large community members, and community health workers (n=169). APPROACH: We performed content analysis of the transcripts with NVivo 10 software, using both deductive and inductive codes. We used a two-round Delphi method to rank the barriers identified in the content analysis. We selected factors using triangulation of frequency of codes and themes from the transcripts, in addition to the results of the Delphi exercise. Sociodemographic characteristics of participants were summarized using descriptive statistics. KEY RESULTS: We identified 27 barriers to linkage to hypertension care, grouped into individual (cognitive and emotional) and environmental factors. Cognitive factors included the asymptomatic nature of hypertension and limited information. Emotional factors included fear of being a burden to the family and fear of being screened for stigmatized diseases such as HIV. Environmental factors were divided into physical (e.g. distance), socioeconomic (e.g. poverty), and health system factors (e.g. popularity of alternative therapies). The Delphi results were generally consistent with the findings from the content analysis. CONCLUSIONS: Individual and environmental factors are barriers to linkage to hypertension care in rural western Kenya. Our analysis provides new insights and methodological approaches that may be relevant to other lowresource settings worldwide. INTRODUCTIONCardiovascular disease is the leading cause of mortality worldwide, with 80 % of cardiovascular deaths occurring in lowand middle-income countries (LMICs). 1 Hypertension, a major risk factor for cardiovascular disease, 2 is the leading global risk for mortality. 3 Over the next decade, the global cost of suboptimal blood pressure may approach $1 trillion. 4 Unless it is adequately controlled, hypertension will continue to be responsible for significant morbidity and mortality worldwide. 5 In many LMICs, however, the rates of hypertension treatment and control are low. 6 In Kenya, hypertension treatment and control rates have been reported at 9 % and 3 %, respectively. 7 Poor linkage to hypertension care, manifested as delays in seeking care after screening and referral, has been shown to be associated with increased mortality among pre...

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Factors Associated with Appointment Non-Adherence among African-Americans with Severe, Poorly Controlled Hypertension

Cited by 51 publications

References 35 publications

Self-management practices of smokers with asthma and/or chronic obstructive pulmonary disease: a cross-sectional survey

Self-management practices of smokers with asthma and/or chronic obstructive pulmonary disease: a cross-sectional survey

Chronic and asymptomatic diseases influence the control of hypertension treatment in primary care

Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study

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