Patient, clinician and logistic barriers to blood pressure control among adult hypertensives in rural district hospitals in Rwanda: a cross-sectional study

Autor: R. L. McNamara, T. D. Walker, J. P. Sibomana
Rok vydání: 2018
Předmět:
Blood pressure control
Adult
Male
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty
Time Factors
Antihypertensive agents
Cross-sectional study
Hospitals
Rural
Pharmacy
Blood Pressure
030204 cardiovascular system & hematology
Medication Adherence
03 medical and health sciences
Young Adult
0302 clinical medicine
Medicine
Humans
030212 general & internal medicine
Practice Patterns
Physicians'
Physician's Role
Angiology
Aged
Aged
80 and over
Sub-Saharan Africa
business.industry
Rwanda
Rural district
Middle Aged
Cardiac surgery
Blood pressure
Cross-Sectional Studies
Treatment Outcome
lcsh:RC666-701
Family medicine
Hypertension
Practice Guidelines as Topic
Observational study
Female
Clinical Competence
Guideline Adherence
Cardiology and Cardiovascular Medicine
business
Research Article
Zdroj: BMC Cardiovascular Disorders
BMC Cardiovascular Disorders, Vol 19, Iss 1, Pp 1-8 (2019)
ISSN: 1471-2261
Popis: Background Hypertension management in rural, resource-poor settings is difficult. Detailed understanding of patient, clinician and logistic factors which pose barriers to effective blood pressure control could enable strategies to improve control to be implemented. Methods This cross-sectional, multifactorial, observational study was conducted at four rural Rwandan district hospitals, examining patient, clinician and logistic factors. Questionnaires were administered to consenting adult outpatient hypertensive patients, obtaining information on sociodemographic factors, past management for hypertension, and adherence (by Morisky Medication Adherence 8-item Scale (MMAS-8). Treating clinicians identified local difficulties in providing hypertension management from a standard World Health Organisation list and nominated their preferred treatment regimens. Blood pressure measurements and other clinical data were collected during the study visit and used to determine blood pressure control, according to goals from JNC-8 guidelines. Medication availability and cost at each hospital’s pharmacy were reviewed as logistic barriers to treatment. Results The 112 participating patients were 80% female, with only 41% having completed primary education. Self-reported adherence by the MMAS-8 was high in 77% (86/112) and significantly associated) with literacy, lack of medication side effects and the particular hospital and pharmacy attended (all p 6 out of 8 examined medications available in all pharmacies, cost Conclusions Clinician-based factors are a major barrier to blood pressure control in rural district hospitals in Rwanda, and blood pressure control overall was poor. Patient and logistic barriers to blood pressure were not evident in this study.
Databáze: OpenAIRE
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