Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria

Abstract

Background: In Lagos, Nigeria, approximately 33% of the population suffers from hypertension, yet antihypertensive treatment coverage is low. To improve access to care, a decentralized pharmacy-based hypertension care model was piloted. This study reports on the recruitment strategies used and is part of a larger study to evaluate the feasibility of the care model. Objective: To describe our experience executing three different strategies to recruit hypertensive patients in the program: community hypertension screenings, hospital and pharmacy referral. Methods: Individuals with elevated blood pressure and no history of cardiovascular disease were referred to the program’s recruitment days to see a medical doctor for hypertension diagnosis and enrollment. Individuals were referred from community screenings, tertiary hospital outpatient clinics, and pharmacies participating in the program. For the community screenings, we report the number needed to screen (NNS) to find one individual with elevated blood pressure, the NNS to enroll one individual in the program, and factors associated with enrollment in the program among participants referred. Results: We recruited 226 individuals (69%) in the program via the pharmacies, 97 (30%) via the community screenings, and 2 (<1%) via hospital referral. At the community screenings 3,204 individuals participated, 729 (23%) had elevated blood pressure and 618 (85%) were eligible for referral of whom 142 (23%) visited the recruitment days, and 97 (16%) enrolled. The NNS to find one individual with elevated blood pressure was 5, and the NNS to enroll one individual was 34. Enrollment in the program was associated with advancing age, blood pressure ≥160/100 and currently using antihypertensive medication. Conclusions: Despite the potential attractiveness of community screenings to identify and refer individuals with hypertension, enrollment in the program was low. For future programs we recommend pharmacy referral as individuals seem more inclined to access care through healthcare providers they are familiar with.

Opportunistic screening for diabetes mellitus and hypertension in primary care settings in Karnataka, India: a few steps forward but still some way to go

“…We also found that many persons seeking health care expressed readiness to undergo screening. Willingness is an important predictor for the success of screening for DM and HTN, as reported by previous studies 31 , 32 . The key reason for this finding could be the good rapport that the HCPs shared with the community.…”

Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study

“…This study was part of a larger study investigating the feasibility of a pharmacy-based hypertension care model employing an mHealth app for remote patient monitoring by cardiologists in Lagos [ 18 , 27 ]. Pharmacies constituted a beneficial care provider for patients due to accessibility, attention, adherence, and information provision and we observed that patients’ blood pressure reduced.…”

“…We only assessed patients included in the pilot program and did not include a control group in the design of the study, since the main aim was to investigate the feasibility of the care model. Since it was difficult to recruit patients already in hypertension care at LUTH [ 27 ], we did not estimate the costs of pharmacy-based care compared with costs of regular care from a patient perspective. Costs of implementation and possible savings achieved by task-shifting from medical doctors to the pharmacy staff were also not estimated.…”

“…Patients were identified and recruited in the pilot program through community hypertension screening events, the participating pharmacies, and three outpatient clinics of Lagos University Teaching Hospital (LUTH) from February to May 2016 [ 27 ]. At recruitment, three resident cardiologists and two general practitioners under supervision of a cardiologist assessed inclusion and exclusion criteria (listed below), ineligible individuals were referred to regular hypertension care if necessary.…”

“…Here we report on the following study outcomes: 1) patient retention in the pilot program and reasons for dropping-out, 2) changes in blood pressure during the pilot program and determinants for blood pressure on target or improvement, and 3) the quality of and satisfaction with pharmacy-based care including mHealth. Patients and healthcare providers’ perceptions and practices regarding hypertension, pharmacy-based care, and mHealth [ 18 ], and our experiences with recruitment of patients in the pilot program [ 27 ] are presented elsewhere.…”