Factors affecting patient retention to hypertension treatment in a North Indian State: A mixed-method study

Area of Science:

• Public Health
• Cardiovascular Disease Management
• Health Services Research

Background:

• Hypertension is a significant global health issue, particularly in low-to-middle-income countries with suboptimal awareness and control.
• Poor medication adherence is a major barrier to effective blood pressure management, leading to severe health consequences and increased healthcare costs.
• The Government of India (GOI) has implemented national strategies to combat noncommunicable diseases, including hypertension.

Purpose of the Study:

• To analyze patient retention in hypertension treatment across different healthcare levels in North India.
• To investigate healthcare providers' (HCPs) and patients' perspectives on factors influencing hypertension control.
• To identify barriers to medication adherence and patient follow-up in hypertension management.

Main Methods:

• A mixed-method concurrent study design was employed in a North Indian district.
• Retrospective quantitative data on patient demographics and follow-up rates were collected for one year.
• Qualitative data were gathered through focus group discussions (FGDs) and in-depth interviews (IDIs) with HCPs and patients.

Main Results:

• Only 63% of hypertensive outpatients achieved controlled blood pressure over the study period.
• Patient retention was higher at Health and Wellness Centers (HWCs) compared to higher-level facilities, though blood pressure control was poorer at these higher facilities.
• Key barriers identified included medication side effects, pill burden, limited healthcare access, and poorer follow-up among females.

Conclusions:

• Effective hypertension management necessitates overcoming challenges in patient retention and medication adherence.
• Strengthening primary care services, such as HWCs, with improved access and patient-centered interventions is crucial.
• Addressing specific barriers like medication side effects and healthcare access is vital for improving long-term blood pressure control.