Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013–2014

Abstract

Setting: Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda.Objective: To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home.Design: A retrospective descriptive cohort study using routinely collected data involving adult patients aged 18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014.Results: Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs.Conclusion: By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.

Implementation outcomes of national decentralization of integrated outpatient services for severe non‐communicable diseases to district hospitals in Rwanda

“…Rwanda is working to decentralise and integrate care for common NCDs such as uncomplicated hypertension at the primary care level along with care for other chronic infectious conditions (HIV and TB) and neuropsychiatric conditions (depression, anxiety and epilepsy) [ 15 , 16 ]. These efforts should allow primary hospital outpatient services to focus on more complex, less common diseases.…”

“…Evaluations at the initial PIH/IMB‐supported RMOH DHs demonstrated good implementation feasibility and fidelity with promising clinical outcomes [ 9 , 11 , 12 , 13 , 14 , 15 , 16 ]. Here, we describe the fidelity, penetration and feasibility of scaling this NCD clinic approach for severe NCDs across all 42 DHs in Rwanda.…”

Quality of Care for Patients with Hypertension in selected Health Centres in Rwamagana District, Rwanda

“…[16,17] Rwanda has started the integration of NCDs and their risk factors into the primary health care level. [18,19] The main objective of integration is to improve access to chronic care and care outcomes for patients with NCDs like hypertension. [14] Screening and management of chronic disease services are now included in the essential package of health services delivered in health centers.…”

“…[22] Nurses have now taken responsibility for managing hypertension in primary care settings. [19,20] Nurseled hypertension management can be cost-effective. [13,19,23] Yet, it might be challenging for nurses who are mainly well-equipped to address communicable diseases [3] https://dx.doi.org/10.4314/rjmhs.v6i1.10 ____________________________________________________________________________________________________________________ to manage hypertension which could negatively affect the quality of hypertension care.…”

“…[19,20] Nurseled hypertension management can be cost-effective. [13,19,23] Yet, it might be challenging for nurses who are mainly well-equipped to address communicable diseases [3] https://dx.doi.org/10.4314/rjmhs.v6i1.10 ____________________________________________________________________________________________________________________ to manage hypertension which could negatively affect the quality of hypertension care. In fact, a study conducted in seven rural health care centers from Burera, Kirehe and Kayonza districts in Rwanda indicated that only 40% of patients with hypertension achieved hypertension control after twelve months of follow-up.…”