Team‐based care for hypertensive patients is essential in low‐ and middle‐income countries

Ware, Lisa J.; Schutte, Aletta E.

doi:10.1111/jch.13586

Cited by 2 publications

(2 citation statements)

References 12 publications

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“…While the true reason for poor performance in hypertension management at private health facilities in Ghana is not known, we think that the key reasons included the lack of prioritization and investment in team-based care and the high cost of care. Team-based care involves having multiple healthcare providers across health facilities collaborate to manage patients, and previous studies have demonstrated that it is effective in hypertension management [ 47 , 48 ]. Yet, to minimize expenses, private health facilities de-emphasize the need to hire all key healthcare providers such as pharmacists, dieticians, and community health workers, all of whom are key personnel needed for team-based hypertension care.…”

Section: Discussionmentioning

confidence: 99%

Exploring patient-, provider-, and health facility-level determinants of blood pressure among patients with hypertension: A multicenter study in Ghana

Byiringiro,

Hinneh,

Commodore-Mensah

et al. 2024

PLOS Glob Public Health

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Optimal blood pressure (BP) control is essential in averting cardiovascular disease and associated complications, yet multiple factors influence the achievement of BP targets. We explored patient-, provider-, and health facility-level factors of systolic and diastolic BP and controlled BP status among patients with hypertension in Ghana. Using a cross-sectional design, we recruited 15 health facilities, and from each facility, we recruited four healthcare providers involved in managing hypertension and 15 patients diagnosed with hypertension. The primary outcome of interest was systolic and diastolic BP; the secondary outcome was BP control (<140/90 mmHg) in compliance with Ghana’s national standard treatment guidelines. We used mixed-effects regression models to explore the patient- and facility-level predictors of the outcomes. Two hundred twenty-four patients and 67 healthcare providers were sampled across 15 health facilities. The mean (SD) age of providers and patients was 32 (7) and 61 (13) years, respectively. Most (182 [81%]) of the patient participants were female, and almost half (109 [49%]) had controlled BP. At the patient level, traveling for 30 minutes to one hour to the health facility was associated with higher diastolic BP (Coeff.:3.75, 95% CI: 0.12, 7.38) and lower odds of BP control (OR: 0.51, 95% CI: 0.28, 0.92) compared to traveling for less than 30 minutes. Receiving hypertension care at government health facilities than at private health facilities was associated with lower systolic BP (Coeff.: -13.89; 95% CI: -23.99, -3.79). A higher patient-to-physician or physician-assistant ratio was associated with elevated systolic BP (Coeff.: 21.34; 95% CI: 8.94, 33.74) and lower odds of controlled BP (OR: 0.19, 95% CI: 0.05, 0.72). Along with addressing the patient-level factors influencing BP outcomes in Ghana, there is a need for public health and policy interventions addressing the inaccessibility of hypertension services, the shortage of clinical care providers, and the underperformance of private health facilities.

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Section: Discussionmentioning

confidence: 99%

Exploring patient-, provider-, and health facility-level determinants of blood pressure among patients with hypertension: A multicenter study in Ghana

Byiringiro,

Hinneh,

Commodore-Mensah

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…While it is not very clear why hypertension care in private health facilities is associated with poor outcomes, a few elements could offer some explanations. One strategy that has shown to be effective in hypertension management is team-based care-where healthcare professionals collaborate to manage patients with hypertension [54]. Yet, to minimize expenses, private health facilities deemphasize the need to hire all key healthcare professionals such as pharmacists, dieticians, community health workers and others.…”

Section: Discussionmentioning

confidence: 99%

Exploring patient-, provider-, and health facility-level determinants of blood pressure among patients with hypertension: A multicenter study in Ghana

Byiringiro,

Hinneh,

Commodore-Mensah

et al. 2023

Preprint

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Optimal blood pressure (BP) control is essential in averting cardiovascular disease and associated complications. Multi-level factors influence the achievement of BP targets in hypertension management. We explored patient-, provider-, and health facility-level factors of systolic and diastolic BP and controlled BP status among patients with hypertension in Ghana, where the burden of hypertension and cardiovascular disease is rising. Using a cross-sectional design, we recruited 15 health facilities, and from each facility, four healthcare professionals who managed patients with hypertension and 15 patients diagnosed with hypertension. The primary outcome of interest was systolic and diastolic BP; the secondary outcome was BP control (<140/90 mmHg) in compliance with Ghana's national standard treatment guidelines. We used mixed-effects regression models to explore the patient- and facility-level predictors of the outcomes. From the 15 health facilities, we recruited 67 healthcare providers with a mean (SD) age of 32 (7) and 224 patients with a mean (SD) age of 60.5 (12.7). Most (182 [81%]) of the patient participants were female, and almost half (109 [49%]) had controlled BP. At the patient level, secondary school education (Coeff.:-7.69, 95% CI: -15.13, -0.26) was associated with lower systolic BP than a lower level of education; and traveling for 30 minutes to 1 hour to the health facility was associated with higher diastolic BP (Coeff.:3.75, 95% CI: 0.12, 7.38) and lower odds of BP control (OR: 0.51, 95% CI: 0.28, 0.92) than traveling less than 30 minutes. Receiving care at government health facilities was associated with less systolic BP (Coeff.: -19.4; 95% CI: -33.58, -5.22) than private health facilities. A higher patient-to-physician or physician assistant ratio was associated with more elevated systolic BP (Coeff.: 23.06, 95% CI: 10.06, 36.05) and lower odds of controlled BP (OR: 0.18, 95% CI: 0.05, 0.74). Further research is warranted to identify effective strategies to address the multi-level factors influencing hypertension control and to mitigate the rising burden of hypertension in Ghana.

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Team‐based care for hypertensive patients is essential in low‐ and middle‐income countries

Cited by 2 publications

References 12 publications

Exploring patient-, provider-, and health facility-level determinants of blood pressure among patients with hypertension: A multicenter study in Ghana

Exploring patient-, provider-, and health facility-level determinants of blood pressure among patients with hypertension: A multicenter study in Ghana

Exploring patient-, provider-, and health facility-level determinants of blood pressure among patients with hypertension: A multicenter study in Ghana

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