Byiringiro Samuel, Hinneh Thomas, Commodore-Mensah Yvonne, Masteller Jill, Sarfo Fred Stephen, Perrin Nancy, Assibey Shadrack, Himmelfarb Cheryl R
Johns Hopkins University, School of Nursing, Baltimore, Maryland, United States of America.
Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLOS Glob Public Health. 2024 Jul 15;4(7):e0002121. doi: 10.1371/journal.pgph.0002121. eCollection 2024.
Optimal blood pressure (BP) control is essential in averting cardiovascular disease and associated complications, yet multiple factors influence the achievement of BP targets. We explored patient-, provider-, and health facility-level factors of systolic and diastolic BP and controlled BP status among patients with hypertension in Ghana. Using a cross-sectional design, we recruited 15 health facilities, and from each facility, we recruited four healthcare providers involved in managing hypertension and 15 patients diagnosed with hypertension. The primary outcome of interest was systolic and diastolic BP; the secondary outcome was BP control (<140/90 mmHg) in compliance with Ghana's national standard treatment guidelines. We used mixed-effects regression models to explore the patient- and facility-level predictors of the outcomes. Two hundred twenty-four patients and 67 healthcare providers were sampled across 15 health facilities. The mean (SD) age of providers and patients was 32 (7) and 61 (13) years, respectively. Most (182 [81%]) of the patient participants were female, and almost half (109 [49%]) had controlled BP. At the patient level, traveling for 30 minutes to one hour to the health facility was associated with higher diastolic BP (Coeff.:3.75, 95% CI: 0.12, 7.38) and lower odds of BP control (OR: 0.51, 95% CI: 0.28, 0.92) compared to traveling for less than 30 minutes. Receiving hypertension care at government health facilities than at private health facilities was associated with lower systolic BP (Coeff.: -13.89; 95% CI: -23.99, -3.79). A higher patient-to-physician or physician-assistant ratio was associated with elevated systolic BP (Coeff.: 21.34; 95% CI: 8.94, 33.74) and lower odds of controlled BP (OR: 0.19, 95% CI: 0.05, 0.72). Along with addressing the patient-level factors influencing BP outcomes in Ghana, there is a need for public health and policy interventions addressing the inaccessibility of hypertension services, the shortage of clinical care providers, and the underperformance of private health facilities.
最佳血压（BP）控制对于预防心血管疾病及相关并发症至关重要，但多种因素会影响血压目标的实现。我们探究了加纳高血压患者收缩压和舒张压以及血压控制状况的患者、医护人员和医疗机构层面的因素。采用横断面设计，我们招募了15家医疗机构，从每家机构中招募了4名参与高血压管理的医护人员和15名被诊断为高血压的患者。主要关注的结果是收缩压和舒张压；次要结果是符合加纳国家标准治疗指南的血压控制（<140/90 mmHg）。我们使用混合效应回归模型来探究结果的患者和机构层面预测因素。在15家医疗机构中对224名患者和67名医护人员进行了抽样。医护人员和患者的平均（标准差）年龄分别为32（7）岁和61（13）岁。大多数（182 [81%]）患者参与者为女性，近一半（109 [49%]）血压得到控制。在患者层面，与出行时间少于30分钟相比，出行30分钟至1小时前往医疗机构与更高的舒张压相关（系数：3.75，95%置信区间：0.12，7.38）以及更低的血压控制几率（比值比：0.51，95%置信区间：0.28，0.92）。在政府医疗机构接受高血压护理与在私立医疗机构相比，收缩压更低（系数：-13.89；95%置信区间：-23.99，-3.79）。更高的患者与医生或医生助理比例与更高的收缩压相关（系数：21.34；95%置信区间：8.94，33.74）以及更低的血压控制几率（比值比：0.19，95%置信区间：0.05，0.72）。除了解决影响加纳血压结果的患者层面因素外，还需要公共卫生和政策干预措施来解决高血压服务不可及、临床护理人员短缺以及私立医疗机构表现不佳的问题。
