Accessibility of care and experiential quality of care for adults with hypertension in rural Burkina Faso: results from a cross-sectional household survey

Abstract

Providing quality healthcare is essential to reduce the future burden of cardiovascular disease. We assessed the quality of hypertension care in Burkina Faso using the Institute of Medicine (IOM) Quality Domains of effectiveness, timeliness of access, patient-centredness and equitability of care. We performed an analysis of cross-sectional household survey data collected from a population-representative sample of 4000 adults ≥40 years in Nouna, Burkina Faso in 2018. For people with hypertension, effectiveness was assessed through the construction of care cascades describing the proportion who were screened, diagnosed, treated, and achieved hypertension control; timeliness was defined as access to care within the last 3 months. Patient-centredness was described using experiential quality process and outcome measures (dichotomised as higher [score above the median] or lower quality [score below and including the median]; a shared understanding and decision-making variable (SUDM) was also described. Equity was assessed for effectiveness, timeliness, and patient-centredness in multivariable analyses, including socio-demographic factors. In total, 1006 participants with hypertension were included. Hypertension prevalence was 34.8%, with 62.3% having previously been screened, 42.9% diagnosed, 15.0% treated, and 6.8% having controlled disease; 26.8% had accessed care within the last three months. Overall, 61.8% of participants had a positive view of the health service. Clarity of communication and opinion of medical provider knowledge were the best-rated experiential quality process variables, with 40.1% and 39.7% of participants' responses indicating higher quality care respectively. The mean SUDM score was 68.5 (±10.8) out of 100.0. Regarding equity, screening was higher in females, adults with any education, those who were married or cohabiting, and those in the higher wealth quintiles. There were no associations seen between SUDM and participant characteristics. Although prevalence of hypertension was high in this population, quality of care was not commensurate, with room for improvement in all four of the IOM Domains assessed.