Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013–2014
Objective: To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home.
Design: A retrospective descriptive cohort study using routinely collected data involving adult patients aged 18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014.
Results: Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs.
Conclusion: By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.
Keywords: integration; mentorship; non-communicable diseases; operational research; retention
Document Type: Research Article
Affiliations: 1: Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda 2: Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda, Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA 3: Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA, Partners In Health, Boston, MA, USA 4: Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg 5: Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA, Nuffield Department of Population Health, University of Oxford, Oxford, UK 6: Ministry of Health, Kigali, Rwanda, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda 7: Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg, Department of Global Health, University of Washington, Seattle, WA, USA 8: Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Publication date: 21 December 2019
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