Ps-p12-5: challenges for registered patients receiving hypertension care from primary health centers in bangladesh

Introduction: One in every five adults in Bangladesh suffers from Hypertension. There is a high prevalence of undetected hypertensive patients. Among the detected cases, the control rate of hypertension is poor. Since 2018, the National Heart Foundation of Bangladesh has undertaken an intensive hypertension control program along with the Non-Communicable Disease Control (NCDC) program, the Government of Bangladesh at primary health care settings. This control program implements a number of proven strategies which are a standard simplified treatment protocol, community-based care and task sharing, regular supply of medication, and patient-centered care. Irregular follow up visit and non-adherent to medication fail to control hypertension and increase premature death among patients. Objectives: To identify the challenges and barriers to the adherence of antihypertensive medication. Design and method: A cross sectional study where total number of 6498 registered hypertensive patients of four Upazila Health Complexes (UHC)s in Sylhet district, northeast part of Bangladesh is selected from April 2019 to August 2020 for this study purpose. These patients are identified since they missed all of their three consecutive monthly follow-up visits at their respective UHCs.. A digital android based application is used as the monitoring tool in the program through which patients are identified as overdue. Data were collected by a questionnaire through an interview over telephone. Result: Among 6498 registered hypertensive patients, 3548 patients were contacted. Among those 47% mentioned the distance to the UHCs and long waiting time as challenging factors for receiving antihypertensive medications monthly from their assigned facilities. Due to poor treatment compliance, a number of patients (2.9%) did not return. Moreover, 3.3% of the respondents switched to private practitioners and 0.2% moved to the secondary or tertiary hospital. 0.6% of the respondents could not receive the antihypertensive medication from UHC due to their physical illness and 0.3% migrated to another location. The interviewer found 0.4% overdue patients dead. 12.9% did not receive the call and 8.6% did not mention any reason. 23.5% of the overdue patients gave wrong phone number during their registration. Conclusion: This study revealed a number of challenges mentioned by the respondents receiving hypertension care from primary health centers. Addressing these challenges might be effective to improve the hypertension care. Hypertension treatment at community level from the nearest health facility should be included to overcome the barriers.