Outcomes of a hypertension care program based on task-sharing with private pharmacies: a retrospective study from two blocks in rural India

Abstract

Low density of formal care providers in rural India results in restricted and delayed access to standardized management of hypertension. Task-sharing with pharmacies, typically the first point of contact for rural populations, can bridge the gap in access to formal care and improve health outcomes. In this study, we implemented a hypertension care program involving task-sharing with twenty private pharmacies between November 2020 and April 2021 in two blocks of Bihar, India. Pharmacists conducted free hypertension screening, and a trained physician offered free consultations at the pharmacy. We calculated the number of subjects screened, initiated on treatment (enrolled) and the change in blood pressure using the data collected through the program application. Of the 3403 subjects screened at pharmacies, 1415 either reported having a history of hypertension or had elevated blood pressure during screening. Of these, 371 (26.22%) were enrolled in the program. Of these, 129 (34.8%) made at least one follow-up visit. For these subjects, the adjusted average difference in systolic and diastolic blood pressure between the screening and follow-up visits was -11.53 (-16.95 to -6.11, 95% CI) and -4.68 (-8.53 to -0.82, 95% CI) mmHg, respectively. The adjusted odds of blood pressure being under control in this group during follow-up visits compared to screening visit was 7.07 (1.29 to 12.85, 95% CI). Task-sharing with private pharmacies can lead to early detection and improved control of blood pressure in a resource-constrained setting. Additional strategies to increase patient screening and retention rates are needed to ensure sustained health benefits.

Fig. 1. The arrows show an individual’s movement through the various steps in the Bihar Pharmacist Hypertension Study.

It starts with a blood pressure screening by the pharmacist, and then the individual follows the flow diagram.

Fig. 2. Subject cascade in the program.

The numbers in parenthesis indicate the percentage conversion from the previous step. ^{^1}27 Previously Undiagnosed individuals had their first consultations post enrolment. ^{^2}85 Previously Diagnosed individuals had their first consultations post enrolment.

Fig. 3. Change in systolic and diastolic blood pressure for enrolled individuals with one or more follow-up visits.

Change in SBP (or DBP) (in mmHg) is the difference in SBP (or DBP) at screening and SBP (or DBP) at the last follow-up visit (with negative values indicating a reduction in blood pressure). The box plot represents the Interquartile range with the solid line and dashed line within the box indicating the median and mean. The whiskers indicate the values within ranging between 1.5*IQR below the lower quartile and 1.5*IQR above the upper quartile. The outlier dots are beyond the 1.5*IQR values.