The Long and Winding Road: A Systematic Literature Review Conceptualising Pathways for Hypertension Care and Control in Low- and Middle-Income Countries
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Key result
Health system resources and patient knowledge are key barriers at entry to hypertension care, whereas social relations, traditions, and comorbidities become more important during follow-up.
Why the study?
Hypertension control is poor, particularly in low- and middle-income countries, and an effective response requires identifying barriers and facilitators along the patient pathway through the health system.
Population
30 studies of hypertensive adults in LMICs
Design
Systematic literature review and narrative synthesis
Authors
Discussion
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Implication
Supports phase-tailored strategies for hypertension control in LMICs; extends prior evidence by mapping barrier shifts along the patient journey.
Study Design
Type
Systematic Review (n=30)
Structured PICO
P
Population
A systematic review of 30 studies examining barriers and facilitators to hypertension care and control among adults in low- and middle-income countries.
E
Exposure
Assessment of barriers and facilitators to hypertension control along the patient pathway (entry, treatment initiation, and long-term management).
O
Outcome
Barriers to and facilitators of hypertension control along the patient pathway.
Understanding the changing barriers to hypertension control along the patient journey, from health system resources at entry to social factors during follow-up, is necessary to improve care in LMICs.
Limitations
- Most studies reported only two points of the care continuum and were not designed to capture intervening barriers and facilitators.
- Studies following the patient along the entire pathway often failed to differentiate the various stages.
- Studies often take a top-down perspective, defining treatment stages according to a predetermined clinical pathway rather than reflecting the perspective of the patients.
Cite This Study
Brathwaite et al. (2020) conducted a systematic review in Hypertension (n=30). Hypertension care pathways was evaluated on Barriers and facilitators to hypertension control. Health system resources and patient knowledge are key barriers at entry to hypertension care, whereas social relations, traditions, and comorbidities become more important during follow-up.
Topics
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