Patient Awareness and Clinical Inertia: Obstacles to Hypertension Control in Rural Communities in the Dominican Republic

Patient Awareness and Clinical Inertia: Obstacles to Hypertension Control in Rural Communities in the Dominican Republic

Abstract Background Many obstacles exist for adequate hypertension control, including low individual awareness and clinical inertia (CI). In this study, we aimed to determine hypertension prevalence, awareness, treatment, and control among community residents of rural areas of Peravia in Dominican R...

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Published in:American journal of hypertension Vol. 34; no. 9; pp. 939 - 947
Main Authors: Castro-Dominguez, Yulanka, Trejo Paredes, Maria Camila, Mones, Patricia, Spatz, Erica S, Lombo, Bernardo, Sepulveda, Priscilla, Reyes-Uribe, Olmar, Otero, Jorge, Ramirez, Gisselle, Urena, Pedro, Lopez, Emilton, Dominguez, Boanerges, McNamara, Robert L
Format: Journal Article
Language:English
Published: US Oxford University Press 22-09-2021
Subjects:
blood pressure
clinical inertia
awareness
hypertension
hypertension control
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Summary:Abstract Background Many obstacles exist for adequate hypertension control, including low individual awareness and clinical inertia (CI). In this study, we aimed to determine hypertension prevalence, awareness, treatment, and control among community residents of rural areas of Peravia in Dominican Republic (DR), followed by an assessment of CI in their primary care clinics (PCCs). Methods We interviewed 827 adults from 8 rural communities of Peravia. Demographics, medical history, health care information, and blood pressure (BP) were obtained. We reviewed the community PCC visits of patients with known hypertension or a BP ≥140/90, abstracting medical history and the physician’s action toward uncontrolled BP. Results Of those interviewed, 57% (95% CI: 53%–60%) had hypertension, with 63% (95% CI: 59%–68%) of those aware of their diagnosis. Among individuals with hypertension, 60% (95% CI: 56%–65%) were receiving pharmacological treatment, and only 35% (95% CI: 31%–40%) were controlled. Characteristics associated with awareness were female sex, age >55 years, diabetes, private insurance, and having at least 1 health care visit within the past year. Of the 507 PCC patients reviewed, 340 (67%) had uncontrolled BP. Of these, 220 had no clinical action to address the uncontrolled BP, corresponding to a CI rate of 65%. Conclusions Among rural communities in the DR, undiagnosed hypertension remains common, especially in individuals who are younger, uninsured, or with limited access to health care. For those seen in PCCs, therapeutic intensification to achieve controlled BP is infrequently done. Strategies to address population awareness and CI are needed to improve hypertension control.
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ISSN:0895-7061
1941-7225
DOI:10.1093/ajh/hpab054