Facilitators And Barriers to Hypertension Control, Fol-lowing the Implementation of India Hypertension Con-trol Initiative (IHCI) In Thiruvananthapuram District – A Qualitative Study

Balamurali V; Lavanya P; Kumar  Sumit

doi:10.55489/njcm.131120222410

Authors

Balamurali V Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
Lavanya P JIPMER, Puducherry, India
Kumar Sumit Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India

DOI:

https://doi.org/10.55489/njcm.131120222410

Keywords:

IHCI, Thiruvananthapuram, Facilitators, Barriers

Abstract

Background: India Hypertension Control Initiative (IHCI) was launched in 2017 to improve the control rate of hypertensive patients on treatment. Thiruvananthapuram was one among the 26 districts in the country where the program was initially rolled out.

Methods: A qualitative cross-sectional study was conducted among stakeholders involved in the implementation of IHCI of Thiruvananthapuram district. Purposive sampling method was used for selection of samples. A total of 25 in-depth interviews were carried out.

Results: The major facilitators which propelled hypertension control were uniformity in drug prescription, proper documentation of patient data along with indicators for measuring control rates and defaulter tracking mechanism. Clinical inertia among doctors, increased workload and sending of bystanders for monthly follow-up are the major barriers that affected hypertension control.

Conclusions: Replication of good practices performed under IHCI into similar health settings or programs can be encouraged. Apart from the few barriers seen at the program level, the already existing barriers at the health system level need to be addressed immediately through efforts such as e-Health incorporation, trainings .

References

Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO.

WHO Global action plan for the prevention and control of noncommunicable diseses 2013- 2020, World Health Organization, Gene-va, Switzerland (2013)

Reddy KS, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. The Lancet. 2005 Nov 12;366(9498):1744-9. Doi: https://doi.org/10.1016/S0140-6736(05)67343-6

Prenissl J, Manne-Goehler J, Jaacks LM, Prabhakaran D, Awasthi A, Bischops AC, et al. Hypertension screening, awareness, treat-ment, and control in India: A nationally representative cross-sectional study among individuals aged 15 to 49 years. PLoS medicine. 2019 May;16(5). Doi: https://doi.org/10.1371/journal.pmed.1002801 PMid:31050680 PMCid:PMC6499417

Soman CR, Shahulhameed S, Ramankutty V, Vijayakumar K, Kunjukrishnapillai R, Ajayan K, et al. PROLIFE study group. Cohort pro-file: the PROLIFE study in Kerala, India. International journal of epidemiology. 2011 Feb 1;40(1):10-4. Doi: https://doi.org/10.1093/ije/dyp275 PMid:19740760

Achutha Menon Centre for Health Science Studies (AMCHSS). Prevention and Control of Noncommunicable Diseases in Kerala. Tri-vandrum: s.n., 2016-17.

Links community, IHCI Training Manual. Available from: https://linkscommunity.org/assets/PDFs/htn-draft-training-module_non- simple_05122019-for-print.pdf . Accessed 12 May 2020

ICMR, Press release-Expansion for India Hypertension Control Initiative (IHCI). Available from:https://www.icmr.nic.in/sites/default/files/press_realease_files/IHCI_op.pdf. Accessed on 07 May 2020].

Frieden TR, King SM, Wright JS. Protocol-based treatment of hypertension: a critical step on the pathway to progress. JAMA. 2014 Jan 1;311(1):21-2. Doi: https://doi.org/10.1001/jama.2013.282615 PMid:24231925

Jaffe MG, Frieden TR, Campbell NRC, Matsushita K, Appel LJ, Lackland DT, et al. Recommended treatment protocols to improve man-agement of hypertension globally: A statement by Resolve to Save Lives and the World Hypertension League (WHL). J Clin Hyper-tens (Greenwich). 2018 May;20(5):829-836. Doi: https://doi.org/10.1111/jch.13280 PMid:29700951 PMCid:PMC8030787

Heller DJ, Kumar A, Kishore SP, Horowitz CR, Joshi R, Vedanthan R. Assessment of Barriers and Facilitators to the Delivery of Care for Noncommunicable Diseases by Nonphysician Health Workers in Low-and Middle-Income Countries: A Systematic Review and Qualitative Analysis. JAMA Network Open. 2019 Dec 2;2(12):e1916545-. Doi: https://doi.org/10.1001/jamanetworkopen.2019.16545 PMid:31790570 PMCid:PMC6902752

Khatib R, Schwalm JD, Yusuf S, Haynes RB, McKee M, Khan M, Nieuwlaat R. Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PloS one. 2014;9(1). Doi: https://doi.org/10.1371/journal.pone.0084238 PMid:24454721 PMCid:PMC3893097

Kashyap VH, Shivaswamy MS. Assessment of implementation of the national programmeme for the prevention and control of can-cer, diabetes, cardiovascular diseases, and stroke at subcenters of Belagavi taluka: A cross-sectional study. Indian Journal of Health Sciences and Biomedical Research (KLEU). 2019 Jan 1;12(1):21. Doi: https://doi.org/10.4103/kleuhsj.kleuhsj_232_18

Gupta R, Khedar RS, Panwar RB. Strategies for better hypertension control in India and other lower middle-income countries. J As-soc Physicians India. 2016 Sep;64(9):58-64.