Attrition and associated factors among patients on chronic antihypertensive therapy at Mulago hospital, Uganda: A
Nathan Ntenkaire1,2, Mark Kaddu Mukasa3, Patience Muwanguzi1,4
1Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda.
Insights
High attrition rates in hypertension care, exceeding 56%, necessitate improved patient retention strategies. Targeted interventions are crucial for high-risk groups to ensure consistent blood pressure management and prevent serious health issues.
Area of Science:
- Public Health
- Clinical Medicine
- Health Services Research
Background:
- Patient attrition in chronic antihypertensive therapy is a significant issue, leading to uncontrolled blood pressure and adverse health outcomes.
- Understanding the factors contributing to treatment discontinuation is vital for healthcare providers to improve patient adherence and outcomes.
- This study investigated attrition and its associated factors among hypertensive patients between January 2020 and December 2022.
Purpose of the Study:
- To assess the proportion of attrition among patients undergoing chronic antihypertensive therapy.
- To identify factors associated with attrition (loss to follow-up) in hypertensive patients.
- To inform the development of strategies for improving patient retention in hypertension management.
Main Methods:
- A sequential explanatory mixed-methods design was employed, combining quantitative retrospective cohort data from 1215 patients with qualitative data from 16 patients.
- Quantitative data analysis utilized extended Cox regression to identify factors associated with time to attrition.
- Qualitative data analysis involved thematic analysis using a codebook to explore patient experiences and barriers to follow-up.
Main Results:
- The overall attrition proportion was 56.8%, with the highest rate in 2020 (64.9%) and the lowest in 2021 (54.7%).
- Factors associated with attrition included older age, female sex, residence outside the capital city, later cohort entry year, and last visit systolic and diastolic blood pressure.
- Loss to follow-up was attributed to structural and contextual barriers, health system challenges, and patient-related factors like illness perceptions and health limitations.
Conclusions:
- The high attrition rate (56.8%) falls significantly below the CDC's 80% retention target, highlighting an urgent need for improved retention strategies.
- Specific high-risk groups, such as males and patients residing far from health facilities, require targeted support.
- Implementing patient-centered approaches that address structural and health system barriers is essential for enhancing retention in hypertension care.
Background:
Attrition among patients on chronic antihypertensive therapy is a significant problem that can lead to serious health consequences, including uncontrolled blood pressure. Several factors underlie attrition, so healthcare providers must address them to prevent treatment discontinuation and ensure optimal outcomes. Therefore, this study assessed attrition and associated factors among hypertensive patients from January 2020 and December 2022.
Methods:
A sequential explanatory mixed-methods design. The quantitative study was a retrospective cohort study design using files of 1215 hypertensive patients. The qualitative study employed an explanatory descriptive design among 16 patients. A data abstraction tool and an interview guide were used for data collection. Attrition was defined as patients who were lost to follow-up. Extended Cox regression was used to determine the factors associated with time to attrition at 5% level of significance and qualitative data analysis employed a thematic analysis codebook.
Results:
The attrition proportion was 56.8% (95% confidence interval (CI) 54.0-59.7) with most patients getting lost to follow-up in 2020 (64.9%) and fewest in 2021 (54.7%). Age (hazard ratio (HR)=0.947, 95% CI 0.931-0.963), female Sex (HR = 0.734, 95% CI 0.620-0.869), residence outside Kampala (Capital City) (HR = 1.24, 95%CI 1.063-1.455), 2022 cohort entry year (HR = 1.433, 95% CI 1.156-1.777), last visit systolic blood pressure (SBP) (HR = 1.014, 95% CI 1.009-1.018), and last visit diastolic blood pressure (DBP) (HR = 0.947,95% CI 0.931-0.963) were associated with time to attrition. Loss to follow-up (LTFU) was driven by structural and contextual barriers, health system challenges, and illness perceptions and health-related limitations.
Conclusion:
Hypertensive patient attrition proportion is high, below the Centers for Disease Control and Prevention's 80% retention target. This calls for innovative retention strategies, and targeted support for high-risk groups like the male patients and those distant from the health facility. Patient-centered approaches addressing structural and health system barriers are essential to improving retention in hypertension care.
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