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.

backgroundSub-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.

aimThis 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.

settingTwo private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives.

methodsA 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.

resultsMedication 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.

conclusionsIn 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.