The outpatient management of hypertension at two Sierra Leonean health centres: A mixed-method investigation of follow-up compliance and patient-reported barriers to care

Abstract

Background Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region. Aim This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management. Setting Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives. Methods A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care. Results Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care. Conclusions In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts.

Follow-up care delivery in community-based hypertension and type 2 diabetes management: a multi-centre, survey study among rural primary care physicians in China

“…A home visit on top of routine care delivered at clinic consultation rooms is more likely to reach patients who are busy during office hour or those with disabilities, and thus physicians are more prone to achieve the recommended goal of follow-up frequency. This echoes existing literature on patient-reported barriers to routine follow-up care for hypertension and diabetes in low-income settings, including but not limited to transportation, financial burden and schedule conflicts, along with treatment adherence and satisfaction [ 45 , 46 ]. Besides, it has been suggested that therapeutic-related factors could also be related with achieving optimal practices in disease management on top of health education [ 16 , 17 , 34 ].…”

“…Thirdly, confounders potentially associated with care delivery such as job satisfaction may not be fully adjusted for in this study, and a physician self-report survey will inevitably restrict inclusion of questions relating to individual characteristics at patient-level. Accordingly, we were unable to differentiate whether patients aren’t coming back out of their own volition versus because of the provider, despite the possibility that patient-level barriers such as transportation, financial burden and schedule conflicts might play a role [ 45 , 46 ]. Fourthly, factors associated with target non-attainment in this study may not directly indicate its correlation with patient outcomes, and the use of a specific health-status measurement as the primary outcome from the patient’s perspective is warranted in future studies.…”

Evaluating the cascade of care for hypertension in Sierra Leone

“…In 2020, the costs for a visit to one of the health facilities was about 40,000 Leones (US$4.75) and costs for antihypertensive medication for a month 50,000 Leones (US$6.00). According to recent 2021 estimates from UNDP 60% of Sierra Leoneans live on less than US$1.25 a day, illustrating how very few people can afford treatment for their hypertension [ 37 , 38 , 39 ]. The shortage of medicines in public facilities drives patients to purchase from private pharmacies or informal sources associated more often with poor quality medicines, which may also result in ineffective treatment [ 32 ].…”

Determinants of Self-Care and Home-Based Management of Hypertension: An Integrative Review

“…The results showed an affirmation of all the qualitative appraisal questions. Another study [29] was assessed under the mixed methods section and was also affirmative to all the questions.…”

“…The studies were conducted in various countries, including Tanzania [27], Ethiopia [32,33,34,35,36], Ghana [37], Sierra Leone [29], Cameroon [38], Eritrea [28], South Africa [26,39], and Kenya [40]. The various studies used diverse study designs.…”