Determinants of adherence to antihypertensive treatment among patients attending a primary care clinic with limited medical armamentarium in Delhi, India: A qualitative study

Objective To determine perspectives on reasons for non-adherence to antihypertensive therapy and its socioeconomic determinants among patients attending a primary care center in a low-income area in Delhi, India. Methods We conducted in-depth interviews with a total of 30 patients having hypertension at a primary care facility located in a low-income urban area in Delhi. Results All the participants were aware that hypertension was a serious illness, and medication intake was necessary throughout life to prevent uncontrolled hypertension. All participants in varying quantities practiced salt restriction, but the consumption of fresh fruit and vegetables was low primarily due to economic reasons. The participants were unable to differentiate the concept of exercise from physical activity. Medication adherence was suboptimal, and significant reasons for non-adherence were forgetfulness, carelessness and running out of drug stocks. Blood pressure control was also suboptimal in a majority of the participants, but combination therapy was restricted due to limited medical armamentarium at the clinic. Laboratory investigations for monitoring target end-organ damage were either delayed or not conducted in most participants. Discussion Hypertensive patients undergoing treatment at primary care facilities often report suboptimal medical adherence and treatment outcomes, with socioeconomic causes being a major driver of non-adherence.

Download Full-text

Experiences and Beliefs of Low‐Income Patients with Hypertension in Louisiana and Mississippi during the COVID‐19 Pandemic

Journal of the American Heart Association ◽

10.1161/jaha.120.018510 ◽

2020 ◽

Author(s):

Katherine T. Mills ◽

Erin Peacock ◽

Jing Chen ◽

Amanda Zimmerman ◽

Hua He ◽

...

Keyword(s):

Primary Care ◽

Low Income ◽

Primary Care Clinic ◽

Treatment Strategies ◽

Pressure Control ◽

Healthcare Services ◽

Poverty Level ◽

Antihypertensive Medications ◽

Patient Centered ◽

Care Clinic

Abstract Background The coronavirus disease 2019 (COVID‐19) pandemic disproportionately affects individuals with hypertension and health disparities. Methods and Results We assessed experiences and beliefs of low‐income and minority patients with hypertension during the COVID‐19 pandemic. Participants (N=587) from the Implementation of Multifaceted Patient‐Centered Treatment Strategies for Intensive Blood Pressure Control (IMPACTS‐BP) study completed a telephone survey in May and June of 2020. Participants were 65.1% Black, 59.7% female, and 57.7% reported an income below the federal poverty level. Overall, 2.7% tested positive and 15.3% lost a family member or friend to COVID‐19. These experiences were significantly more common in Black (3.9% and 19.4%, respectively) than in non‐Black participants (0.5% and 7.8%, respectively). Further, 14.5% lost a job and 15.9% reported food shortages during the pandemic. Most participants complied with stay‐at‐home orders (98.3%), social distancing (97.8%), and always wearing a mask outside their home (74.6%). Participants also reported high access to needed healthcare (94.7%) and prescription medications (97.6%). Further, 95.7% of respondents reported that they continued to take their regular dosage of antihypertensive medications. Among the 44.5% of participants receiving a healthcare appointment by telehealth, 96.6% got the help they needed, and 80.8% reported that the appointment quality was as good as or better than in‐person visits. Finally, 88.9% were willing to return to their primary care clinic. Conclusions These data suggest that low‐income patients, especially Black patients, were negatively impacted by COVID‐19. However, most patients were able to access needed healthcare services and were willing to return to their primary care clinic for hypertension management.

Download Full-text

Prescribing patterns of antihypertensive medications and blood pressure control among hypertensive patients in a primary care setting in Malaysia

Progress in Drug Discovery & Biomedical Science ◽

10.36877/pddbs.a0000055 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Jun-Ming Ng ◽

Kok Pim Kua ◽

Shaun Wen Huey Lee

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Blood Pressure Control ◽

Primary Care Clinic ◽

Care Facility ◽

Pressure Control ◽

Prescribing Patterns ◽

Antihypertensive Medications ◽

Care Clinic ◽

Utilisation Data

Aims: This study aims to describe the prescribing patterns of antihypertensive medications and short term outcomes of these patients, defined as repeat blood pressure measurements by a medical professional within 6 months, in a primary care facility in Puchong, located within the state of Selangor in Malaysia. Methods: This study was a cross-sectional, retrospective analysis of patients with essential hypertension, aged 18 and above, with blood pressure recorded at least twice within a 6-month period in an urban primary care clinic in Malaysia. Patients with history of co-morbidities were excluded. The prescribing patterns of antihypertensive medications and proportion of patients who achieved blood pressure control of less than 140/90 mmHg were ascertained. Results: A total of 200 prescriptions were analysed, including 52.5% females taking a mean of 1.7 (0.7) antihypertensive medications with a mean age of 57.9 (12.4) years. Most of the patients were prescribed either a single medication (n=90, 45.0%) or two medications (n=90; 45.0%) to control their blood pressure. Only 20 patients (10.0%) were prescribed three antihypertensive medications. A total of 127 (63.5%) patients met the blood pressure target of less than 140/90 mmHg. All participants exhibited a significant drop in systolic blood pressure, reducing from 143.0 (16.0) mmHg at baseline to 135.3 (14.8) mmHg at the end of 6 months (p<0.001). Diastolic blood pressure also decreased significantly from 83.5 (11.7) mmHg at baseline to 79.0 (10.2) mmHg at the end of 6 months (p<0.001). The choice of antihypertensive medications by the prescribers was compliant with the hypertension guidelines of Malaysia. Conclusion: The most commonly prescribed antihypertensive class was calcium channel blockers. Significant reduction in blood pressure was observed in patients from baseline to the follow-up visit. Further research of larger sample size and longer monitoring period is necessary to provide more robust epidemiology and drug utilisation data.

Download Full-text

Using Touch-Screen Technology to Assess Smoking in a Low-Income Primary Care Clinic: A Pilot Study

Substance Use & Misuse ◽

10.3109/10826084.2011.618999 ◽

2011 ◽

Vol 46 (14) ◽

pp. 1750-1754 ◽

Cited By ~ 4

Author(s):

Philip H. Smith ◽

Gregory G. Homish ◽

Christopher Barrick ◽

Nancy L. Grier

Keyword(s):

Primary Care ◽

Pilot Study ◽

Low Income ◽

Primary Care Clinic ◽

Touch Screen ◽

Care Clinic

Download Full-text

713 BLOOD PRESSURE CONTROL AND THE NUMBER OF ANTI-HYPERTENSIVE DRUGS NEEDED AT AN URBAN PRIMARY CARE CLINIC

Journal of Hypertension ◽

10.1097/01.hjh.0000420695.91122.bc ◽

2012 ◽

Vol 30 ◽

pp. e207

Author(s):

Yook-Chin Chia ◽

SiewMooi Ching

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Blood Pressure Control ◽

Primary Care Clinic ◽

Pressure Control ◽

Care Clinic

Download Full-text

Pregnant Hispanic Women: A Mental Health Study

Families in Society The Journal of Contemporary Social Services ◽

10.1177/104438949207300901 ◽

1992 ◽

Vol 73 (9) ◽

pp. 515-521 ◽

Cited By ~ 11

Author(s):

Luis H. Zayas ◽

Nancy A. Busch-Rossnagel

Keyword(s):

Mental Health ◽

Primary Care ◽

Low Income ◽

Mental Health Problems ◽

Hispanic Women ◽

Primary Care Clinic ◽

Health Study ◽

Community Based ◽

Care Clinic ◽

Mental Health Study

By most accounts, pregnant Hispanic women are a population at risk for perinatal health and mental health problems. In this article, the authors report on a pilot study of the mental health status of 86 low-income, pregnant Hispanics. Three cases drawn from a community-based, primary care clinic demonstrate how Hispanic women may appear in the clinical setting and how interventions can be designed.

Download Full-text