Attrition and associated factors among patients on chronic antihypertensive therapy at Mulago hospital

Abstract

Introduction: Attrition among patients on chronic antihypertensive therapy (AHT) is a significant problem that can lead to serious health consequences, including uncontrolled blood pressure, cardiovascular diseases, stroke, sexual dysfunction, loss of kidney functions, and blindness. Multiple factors contribute to this issue, and healthcare providers must be mindful of them to prevent treatment discontinuation and ensure optimal patient outcomes. Objective: To assess attrition and associated factors among patients on chronic antihypertensive therapy at Mulago Hospital. Methods: A sequential explanatory mixed-methods design was conducted among 1215 hypertensive patients at Mulago Hospital between January 2020 and December 2022. The quantitative study was a retrospective cohort study design and the qualitative study employed an explanatory descriptive design. An abstraction tool and interview guides were used to gather the data required to accomplish the study goals. Extended Cox model was used to determine the factor associated with time to attrition at <0.05 level of significance. Attrition was characterized as patients who were lost to follow-up, and loss to follow-up was defined as patients who missed ≥2 consecutive appointment visits from the last visit date to the clinic. Results: Attrition rate was at 56.8% (95%CI 54.0-59.7) with most patients getting lost to follow-up in 2020 (64.9%) and the least in 2021 (54.7%). Age (HR=0.904, 95% CI 0.877-0.932), gender: female (HR=0.713, 95% CI 0.602-0.845), residence: outside Kampala (HR=1.311,95%CI 1.121-1.533), last visit systolic blood pressure (SBP) (HR=1.013,95% CI 1.008-1.017), and last visit diastolic blood pressure (DBP) (HR=0.957,95% CI 0.925-0.990) were associated with time to attrition. Financial constraints, medical rudeness, and COVID-19 restriction measures were among the underlying reasons for attrition. Conclusion: The hypertensive patient attrition rate at Mulago Hospital is high, making retention rates considerably below the Centers for Disease Control and Prevention's 80% retention target. This calls for innovative retention strategies and targeted support for high-risk groups like young, males and those living far from the health facility.