Original Research

The outpatient management of hypertension at two Sierra Leonean health centres: A mixed-method investigation of follow-up compliance and patient-reported barriers to care

Jenna Herskind, Jon Zelasko, Karlin Bacher, David Holmes
African Journal of Primary Health Care & Family Medicine | Vol 12, No 1 | a2222 | DOI: https://doi.org/10.4102/phcfm.v12i1.2222 | © 2020 Jenna Herskind, Jon Zelasko, Karlin Bacher, David Holmes | This work is licensed under CC Attribution 4.0
Submitted: 12 August 2019 | Published: 17 June 2020

About the author(s)

Jenna Herskind, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
Jon Zelasko, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States
Karlin Bacher, Sierra Leone Directory of Partnerships and Development, Jericho Road Community Health Centre, Freetown, Sierra Leone
David Holmes, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, United States


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Abstract

Background: Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region.

Aim: This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management.

Setting: Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives.

Methods: A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care.

Results: Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care.

Conclusions: In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts.


Keywords

hypertension; medication compliance; Sierra Leone; family medicine; outpatient management

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