Socioeconomic and modifiable predictors of blood pressure control for hypertension in primary care attenders in the Western Cape, South Africa

Q: What are the key findings of this study?

Higher education (tertiary vs none) was associated with lower odds of uncontrolled baseline blood pressure among 3,220 hypertensive patients in South Africa.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=3220). Intervention: Patient socioeconomic status (e.g., tertiary education vs none) and primary healthcare facility characteristics vs. No formal education / reference socioeconomic and clinic characteristics. Primary outcome: Uncontrolled blood pressure at baseline (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) (OR 0.35, 95% CI 0.18 - 0.68, p=0.002).

Q: What does this research mean for the field?

Higher educational attainment is associated with significantly lower odds of uncontrolled blood pressure among hypertensive patients attending primary care clinics in South Africa. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Naomi Folb; Max Bachmann; Eric D. Bateman; Krisela Steyn; Naomi Levitt; Venessa Timmerman; Carl Lombard; Thomas A. Gaziano; Lara Fairall

doi:10.7196/samj.2016.v106.i12.12005

December 1, 2016South African Medical JournalOpen Access

Socioeconomic and modifiable predictors of blood pressure control for hypertension in primary care attenders in the Western Cape, South Africa

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Key result

Higher education linked to ~65% lower odds of uncontrolled baseline blood pressure in hypertension.

OR 0.35
95% CI 0.18 - 0.68
P=0.002
n=3,220

Why the study?

Are patient socioeconomic status and primary healthcare facility characteristics associated with blood pressure control and treatment intensification in hypertensive patients attending public primary care clinics in South Africa?

Study Design

Type

Cohort (n=3,220)

Multicenter

Yes

Structured PICO

Are patient socioeconomic status and primary healthcare facility characteristics associated with blood pressure control and treatment intensification in hypertensive patients attending public primary care clinics in South Africa?

P

Population

3,220 adults with treated hypertension (mean age 54.8 years, 75.1% female) attending 38 public sector primary care clinics in the Western Cape, South Africa, followed for 14 months.

E

Exposure

Patient socioeconomic indicators (higher education level, English/isiXhosa language, monthly income, employment, welfare grant) and primary care clinic characteristics (off-site drug supply, daily doctor attendance, number of clinic nurses, pharmacist presence, PC101 intervention arm).

C

Comparator

Reference socioeconomic and clinic categories (e.g., no formal education, Afrikaans language, lower clinic staffing, no off-site drug supply, control clinic arm).

O

Outcome

Uncontrolled blood pressure (defined as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) at baseline and at 14-month follow-up.surrogate

Main Result

Odds Ratio: 0.35 (95% CI 0.18–0.68)

p-value: p=0.002

Identifies modifiable clinic factors (off-site drug delivery, daily doctor presence, higher nurse staffing) and patient education/language barriers that influence blood pressure control and treatment intensification in South African primary care.

Limitations

Inclusion in the hypertension group was based on self-reported medication use, and evidence of hypertension treatment was not found in 5% (153) of baseline prescription records.
No assessments of medication adherence were performed at baseline.
Potential language barriers as not all interviewers were fluent in the participant's language of choice (e.g., isiXhosa).
Homogeneity (limited range of socioeconomic status) of the predominantly low-income study population may have limited assessment of individual determinants.
Patients were included on the basis of self-reported use of medication for hypertension, and evidence of treatment was not found in 5% (153) of baseline prescription records.
Potential language barriers as interviewers may not have communicated effectively in the participant's language of choice.
Homogeneity (limited range of socioeconomic status) of the study population may have limited assessment of the impact of individual determinants of blood pressure control.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Tertiary education may influence BP control in South African primary care; leaves open whether addressing educational disparities improves outcomes.

Abstract

BACKGROUND: Low socioeconomic status is associated with the risk of hypertension. There are few reports of the effect of socioeconomic and potentially modifiable factors on the control of hypertension in South Africa (SA). OBJECTIVES: To investigate associations between patients' socio-economic status and characteristics of primary healthcare facilities, and control and treatment of blood pressure in hypertensive patients. METHODS: We enrolled hypertensive patients attending 38 public sector primary care clinics in the Western Cape, SA, in 2011, and followed them up 14 months later as part of a randomised controlled trial. Blood pressure was measured and prescriptions for antihypertension medications were recorded at baseline and follow-up. Logistic regression models assessed associations between patients' socioeconomic status, characteristics of primary healthcare facilities, and control and treatment of blood pressure. RESULTS: Blood pressure was uncontrolled in 60% (1 917/3 220) of patients at baseline, which was less likely in patients with a higher level of education (p=0.001) and in English compared with Afrikaans respondents (p=0.033). Treatment was intensified in 48% (892/1 872) of patients with uncontrolled blood pressure at baseline, which was more likely in patients with higher blood pressure at baseline (p<0.001), concurrent diabetes (p=0.013), more education (p=0.020), and those who attended clinics offering off-site drug supply (p=0.009), with a doctor every day (p=0.004), or with more nurses (p<0.001). CONCLUSION: Patient and clinic factors influence blood pressure control and treatment in primary care clinics in SA. Potential modifiable factors include ensuring effective communication of health messages, providing convenient access to medications, and addressing staff shortages in primary care clinics.

Discussion

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Cite This Study

Folb et al. (2016) conducted a cohort in Hypertension (n=3,220). Patient socioeconomic status (e.g., tertiary education vs none) and primary healthcare facility characteristics vs. No formal education / reference socioeconomic and clinic characteristics was evaluated on Uncontrolled blood pressure at baseline (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) (OR 0.35, 95% CI 0.18 - 0.68, p=0.002). Higher education (tertiary vs none) was associated with lower odds of uncontrolled baseline blood pressure among 3,220 hypertensive patients in South Africa.

synapsesocial.com/papers/6a8ad31d210b9ed19c892c7b https://doi.org/10.7196/samj.2016.v106.i12.12005

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Socioeconomic and modifiable predictors of blood pressure control for hypertension in primary care attenders in the Western Cape, South Africa

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Socioeconomic and modifiable predictors of blood pressure control for hypertension in primary care attenders in the Western Cape, South Africa

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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