Health system competence and care continuity in patients with hypertension: electronic cohort in Uruguay

Despite efforts to improve hypertension management, control rates remain low. Effective control depends on care competence and continuity. We describe health system competence, care continuity, user experience, and health and economic outcomes among individuals with hypertension in Uruguay.

This longitudinal study of randomly selected 200 adults aged ≥35 years with baseline blood pressure >140/90 mmHg and mobile phone access from the CESCAS 2010 cohort.. . Over eight months, participants completed baseline, six telephone follow-up, and a final surveys documenting health status, health system competence, care continuity, patient activation, user experience, and health and economic outcomes.

Mean age was 64.9 (9.7) years; 77% reported 'Excellent/Very good' health. Overall, 79.5% knew they had hypertension and were on treatment; 42.0% of the total sample had controlled blood pressure at baseline. Only 11.5% received all guideline-recommended clinical interventions. Regardless of coverage, 60.8% usually attended a primary care facility. Although 93.5% had at least one visit in 8 months, only 48.8% of newly diagnosed participants completed the three recommended visits. In all, 57.1% received care from the same professional in the same facility. Blood pressure control was achieved by 34.4% of those with known hypertension and 19.5% of newly diagnosed participants. Only 49% reported timely appointments availability. Patient activation was 70.5%, and 68.9% reported autonomy in decision-making.

The low proportion of individuals receiving continuous, competent care, particularly among those newly diagnosed, underscores the need for targeted interventions to improve care quality.