Abstract
ObjectiveThe aim of this study was to assess the impact of regularity in treatment follow-up appointments on treatment outcomes among hypertensive patients attending different healthcare settings in Islamabad, Pakistan. Additionally, factors associated with regularity in treatment follow-up were also identified.MethodsA cross-sectional study was undertaken in selected primary, secondary and tertiary healthcare settings between September, 2017 and December, 2018 in Islamabad, Pakistan. A structured data collection form was used to gather sociodemographic and clinical data of recruited patients. Binary logistic regression analyses were undertaken to determine association between regularity in treatment follow-up appointments and blood pressure control and to determine covariates significantly associated with regularity in treatment follow-up appointments.ResultsA total of 662 patients with hypertension participated in the study. More than half 346 (52%) of the patients were females. The mean age of participants was 54 ± 12 years. Only 274 (41%) patients regularly attended treatment follow-up appointments. Regression analysis found that regular treatment follow-up was an independent predictor of controlled blood pressure (OR 1.561 [95% CI 1.102–2.211; P = 0.024]). Gender (OR 1.720 [95% CI 1.259–2.350; P = 0.001]), age (OR 1.462 [CI 95%:1.059–2.020; P = 0.021]), higher education (OR 1.7 [95% CI 1.041–2.778; P = 0.034]), entitlement to free medical care (OR 3.166 [95% CI 2.284–4.388; P = 0.0001]), treatment duration (OR 1.788 [95% CI 1.288–2.483; P = 0.001]), number of medications (OR 1.585 [95% CI 1.259–1.996; P = 0.0001]), presence of co-morbidity (OR 3.214 [95% CI 2.248–4.593; P = 0.0001]) and medication adherence (OR 6.231 [95% CI 4.264–9.106; P = 0.0001]) were significantly associated with regularity in treatment follow-up appointments.ConclusionAttendance at follow-up visits was alarmingly low among patients with hypertension in Pakistan which may explain poor treatment outcomes in patients. Evidence-based targeted interventions should be developed and implemented, considering local needs, to improve attendance at treatment follow-up appointments.
Highlights
According to the World Health Organisation report, hypertension is the leading cause of morbidity and mortality in the world and is responsible for nine million deaths every year [1]
Patients entitled to free medical care were more likely to attend treatment follow-up visits compared to the patients who had to pay from their own pocket
We have identified several factors associated with regularity in treatment follow-up visits like gender, age, level of education, entitlement status, treatment duration, number of medications, presence of co-morbidity, medication adherence and controlled blood pressure
Summary
According to the World Health Organisation report, hypertension is the leading cause of morbidity and mortality in the world and is responsible for nine million deaths every year [1]. Effective control of blood pressure can only be achieved through lifelong care and regular follow-up [7, 8]. Several interventions have been tested to improve follow-up care among patients with chronic diseases These interventions include increased awareness among patients regarding the benefits of follow-up care, providing free medications, free transport vouchers, telephone/sms reminders and appointment assistance. All these interventions have shown positive effect on regularity in follow-up care among patients [12, 17,18,19]
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