Non-communicable disease care in Sierra Leone : a mixed-methods study of the drivers and barriers to retention in care for hypertension
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVE: To retrospectively analyse routinely collected data on the drivers and barriers to retention in chronic care for patients with hypertension in the Kono District of Sierra Leone.
DESIGN: Convergent mixed-methods study.
SETTING: Koidu Government Hospital, a secondary-level hospital in Kono District.
PARTICIPANTS: We conducted a descriptive analysis of key variables for 1628 patients with hypertension attending the non-communicable disease (NCD) clinic between February 2018 and August 2019 and qualitative interviews with 21 patients and 7 staff to assess factors shaping patients' retention in care at the clinic.
OUTCOMES: Three mutually exclusive outcomes were defined for the study period: adherence to the treatment protocol (attending >80% of scheduled visits); loss-to-follow-up (LTFU) (consecutive 6 months of missed appointments) and engaged in (but not fully adherent) with treatment (<80% attendance).
RESULTS: 57% of patients were adherent, 20% were engaged in treatment and 22% were LTFU. At enrolment, in the unadjusted variables, patients with higher systolic and diastolic blood pressures had better adherence than those with lower blood pressures (OR 1.005, 95% CI 1.002 to 1.009, p=0.004 and OR 1.008, 95% CI 1.004 to 1.012, p<0.001, respectively). After adjustment, there were 14% lower odds of adherence to appointments associated with a 1 month increase in duration in care (OR 0.862, 95% CI 0.801 to 0.927, p<0.001). Qualitative findings highlighted the following drivers for retention in care: high-quality education sessions, free medications and good interpersonal interactions. Challenges to seeking care included long wait times, transport costs and misunderstanding of the long-term requirement for hypertension care.
CONCLUSION: Free medications, high-quality services and health education may be effective ways of helping NCD patients stay engaged in care. Facility and socioeconomic factors can pose challenges to retention in care.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
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| Enthalten in: |
BMJ open - 14(2024), 2 vom: 12. Feb., Seite e077326 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Dibba, Yusupha [VerfasserIn] |
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| Links: |
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| Themen: |
Blood pressure |
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| Anmerkungen: |
Date Completed 14.02.2024 Date Revised 15.02.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/bmjopen-2023-077326 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM368370283 |
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| 245 | 1 | 0 | |a Non-communicable disease care in Sierra Leone |b a mixed-methods study of the drivers and barriers to retention in care for hypertension |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVE: To retrospectively analyse routinely collected data on the drivers and barriers to retention in chronic care for patients with hypertension in the Kono District of Sierra Leone | ||
| 520 | |a DESIGN: Convergent mixed-methods study | ||
| 520 | |a SETTING: Koidu Government Hospital, a secondary-level hospital in Kono District | ||
| 520 | |a PARTICIPANTS: We conducted a descriptive analysis of key variables for 1628 patients with hypertension attending the non-communicable disease (NCD) clinic between February 2018 and August 2019 and qualitative interviews with 21 patients and 7 staff to assess factors shaping patients' retention in care at the clinic | ||
| 520 | |a OUTCOMES: Three mutually exclusive outcomes were defined for the study period: adherence to the treatment protocol (attending >80% of scheduled visits); loss-to-follow-up (LTFU) (consecutive 6 months of missed appointments) and engaged in (but not fully adherent) with treatment (<80% attendance) | ||
| 520 | |a RESULTS: 57% of patients were adherent, 20% were engaged in treatment and 22% were LTFU. At enrolment, in the unadjusted variables, patients with higher systolic and diastolic blood pressures had better adherence than those with lower blood pressures (OR 1.005, 95% CI 1.002 to 1.009, p=0.004 and OR 1.008, 95% CI 1.004 to 1.012, p<0.001, respectively). After adjustment, there were 14% lower odds of adherence to appointments associated with a 1 month increase in duration in care (OR 0.862, 95% CI 0.801 to 0.927, p<0.001). Qualitative findings highlighted the following drivers for retention in care: high-quality education sessions, free medications and good interpersonal interactions. Challenges to seeking care included long wait times, transport costs and misunderstanding of the long-term requirement for hypertension care | ||
| 520 | |a CONCLUSION: Free medications, high-quality services and health education may be effective ways of helping NCD patients stay engaged in care. Facility and socioeconomic factors can pose challenges to retention in care | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a blood pressure | |
| 650 | 4 | |a health equity | |
| 650 | 4 | |a health services accessibility | |
| 650 | 4 | |a hypertension | |
| 650 | 4 | |a patient satisfaction | |
| 650 | 4 | |a quality in health care | |
| 700 | 1 | |a Kachimanga, Chiyembekezo |e verfasserin |4 aut | |
| 700 | 1 | |a Gassimu, Joseph |e verfasserin |4 aut | |
| 700 | 1 | |a Kulinkina, Alexandra V |e verfasserin |4 aut | |
| 700 | 1 | |a Bukhman, Gene |e verfasserin |4 aut | |
| 700 | 1 | |a Gilbert, Hannah N |e verfasserin |4 aut | |
| 700 | 1 | |a Adler, Alma J |e verfasserin |4 aut | |
| 700 | 1 | |a Mukherjee, Joia S |e verfasserin |4 aut | |
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