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

Abstract

BACKGROUND\nMany 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, followed by an assessment of CI in their primary care clinics (PCC).\n\n\nMETHODS\nWe 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 towards uncontrolled BP.\n\n\nRESULTS\nOf 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 one 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%.\n\n\nCONCLUSION\nAmong rural communities in the Dominican Republic, 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.