The Mumbai Hypertension Project, conducted by the global non-profit PATH in the densely populated wards of Dharavi and Ghatkopar, demonstrated after 14 months that the ‘intensive’ ward where more interventions were made had significantly higher blood pressure control rates (29%) compared to the lean ward (14%). The median time to blood pressure control was 97 days in Dharavi clinics against 153 in Ghatkopar clinics.
Dr Asha Hegde, the principal investigator in the study from PATH, said that the impact of patient interventions was eye-opening. “Our key finding is that patients require a push to routinely follow up with a doctor, a step they may deem unnecessary for hypertension compared to other ailments. But once that push is provided, in the form of a simple phone call or focused counselling, there can be significant improvement in outcomes. Secondly, the screening of every patient entering a doctor’s clinic has the potential to unveil numerous undetected cases,” she added.
While hypertension stands as a prominent risk factor for heart attacks, strokes, and kidney diseases, its treatment, though easy, cheap and accessible, has one of the lowest compliance rates. According to 2019 Indian estimates, only 17.3% of treated men and 18.5% of women successfully manage their BP. Of the 13,184 patients enrolled under the project, 10,005 patients had uncontrolled BP at the beginning. Most clinics were catering to the urban slums.
To understand if incentives improved treatment uptake, PATH aided the private clinics with treatment counsellors and coordinators to follow up with patients, while patients were provided free drug vouchers and counselling on diet and adherence. Ghatkopar was classified as ‘lean’ ward with fewer interventions than ‘intensive’ ward Dharavi.
In the intensive ward, hub agents were placed in high patient load clinics to enhance registrations and the uptake of services. More treatment coordinators were provided for monthly follow-up calls, compared to one treatment coordinator for quarterly follow-up calls in the lean ward. Besides the fact that patients who followed up had better BP control, Dr Hegde said it also helped tackle the misconception that patients can stop medication once BP is well managed.
The study found participants under MD providers were the least likely to follow up, while those under MBBS providers demonstrated a higher likelihood compared to those under AYUSH practitioners.