Burden of treatment and blood pressure control of patients with hypertension at a primary care facility, Sedibeng District, Gauteng Province

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dc.contributor.author Pender, DR Kevin
dc.date.accessioned 2019-07-17T12:43:35Z
dc.date.available 2019-07-17T12:43:35Z
dc.date.issued 2018
dc.identifier.uri https://hdl.handle.net/10539/27713
dc.description Submitted in partial fulfilment of the requirements for the award of the MMED (Family Medicine) Degree at the University of Witwatersrand, Johannesburg, South Africa en_ZA
dc.description.abstract Burden of treatment (BOT) refers to the tasks patients, must perform in order to achieve optimal outcomes in their disease management. Hypertension is the commonest chronic disease of lifestyle, and previous studies have shown its control is suboptimal in most settings. Although studies conducted elsewhere have associated poor blood pressure (BP) control with high BOT, it is not known whether this holds true in South Africa, yet this information is important for a comprehensive management approach to hypertension. Previous studies in Sedibeng district have illustrated prevalent poor blood pressure control, however local studies providing understanding of how this relates to BOT are lacking. Objectives: 1. To assess BOT among patients with hypertension at Johan Heyns Community Health Centre (CHC). 2. To determine the proportion of participants with BP controlled to target. 3. To explore the relationship between BOT and BP control. Methods: This was a cross sectional study involving patients at Johan Heyns CHC with hypertension who have been on treatment for a minimum of three months. A treatment burden questionnaire (chronbach alpha 0.89) was administered to participants to collect information on burden of treatment relating to:  Medication regimen  Navigating the healthcare system.  Life style changes, social and financial impacts. In addition, information on participants’ socio-demography and BP readings in the last three months were extracted from medical records. Data was entered into Epi info statistical software, and analysis included descriptive and association tests. Main outcome measures included: Proportion of participants with BP controlled to target, mean total BOT and the association between BOT and blood pressure control. Results: Of 239 participants, most were white (54.2%), female (60.1%), had completed matric or further education (71.9%), married (56.3%), older than 55 years (52.9%) and did not have clinical co-morbidities (56.7%). The mean duration of treatment was 113.8 months, with white people and female participants significantly more likely to have longer duration of treatment (p=0.03 and p=0.04 respectively). Most participants had uncontrolled BP (60.1%), with a mean BP of 143.7/87.2mmHg. Being divorced or african was associated with higher mean systolic BP (p=0.00 and p= 0.012 respectively); being single or male was associated with higher mean diastolic BP (p=0.00 and p=0.03 respectively). The mean total BOT score was 19.7(out of possible 140). Most participants (75%; n=177) reported a low mean BOT score (<47). In the three sub-aggregates of burdens (medication regimen, navigating the health system and lifestyle/social and financial), only 28.4% (n=67) and 15.7% (n=37) reported moderate to high BOT in the components of lifestyle modification/social support and navigating the health system respectively. Among those with clinical comorbidity (n=103), most (66.3%) did not consider hypertension to be more burdensome than the other comorbid illnesses. Single participants were significantly more likely to have a higher mean BOT score (p= 0.00). Although total BOT was not significantly associated with BP control (p=0.53), participants with a higher BOT related to medication regimen were significantly more likely to have an uncontrolled BP (p= 0.04). Conclusion: This study found that patients with hypertension reported low BOT despite most having poorly controlled BP. Considering only a minority reported moderate to high score in the three components of BOT, other elements in the process of care, such as poor healthcare providers’ adherence to guidelines and inertia in intensifying treatment, as well as poor patient compliance to treatment may be responsible for the prevalent poor BP control in the research setting. en_ZA
dc.language.iso en en_ZA
dc.title Burden of treatment and blood pressure control of patients with hypertension at a primary care facility, Sedibeng District, Gauteng Province en_ZA
dc.type Thesis en_ZA
dc.description.librarian XL2019 en_ZA
dc.phd.title PhD en_ZA

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