Jean Pierre Sibomana|Robert L. McNamara|Timothy D. Walker
Patient, clinician and logistic barriers to blood pressure control among adult hypertensives in rural district hospitals in Rwanda: a cross-sectional study
University of Rwanda|Yale University|University of Rwanda
abstract background hypertension management rural resourcepoor settings difficult detailed understanding patient clinician logistic factors pose barriers effective blood pressure control could enable strategies improve control implemented methods crosssectional multifactorial observational study conducted four rural rwandan district hospitals examining patient clinician logistic factors questionnaires administered consenting adult outpatient hypertensive patients obtaining information sociodemographic factors past management hypertension adherence morisky medication adherence 8item scale mmas8 treating clinicians identified local difficulties providing hypertension management standard world health organisation list nominated preferred treatment regimens blood pressure measurements clinical data collected study visit used determine blood pressure control according goals jnc8 guidelines medication availability cost hospitals pharmacy reviewed logistic barriers treatment results 112 participating patients 80 female 41 completed primary education selfreported adherence mmas8 high 77 86112 significantly associated literacy lack medication side effects particular hospital pharmacy attended p lt 005 however 89 patients blood pressure data 26 29 achieved goal blood pressure patient factor statistically associated poor blood pressure control among 30 participating clinicians deficiencies knowledge evident 43 1330 37 1130 chose loop diuretic prescribed medication ideal medication respectively newly diagnosed hypertensive patient without comorbidities counter jnc 8 recommendations 50 1530 identified clinician nonadherence hypertension guidelines barrier pharmacies common antihypertensive medications affordably available gt 6 8 examined medications available pharmacies cost ltus050 per month however clinicians perceived medication cost availability barriers care conclusions clinicianbased factors major barrier blood pressure control rural district hospitals rwanda blood pressure control overall poor patient logistic barriers blood pressure evident study