Changing patterns in Health-seeking behavior and prescription practices for treatment of hypertension in nine districts – insights from India Hypertension Control Initiative, 2018-19 and 2023-24

  1. Prabhdeep Kaur
  2. Kalyani Sailesh
  3. Navaneeth S Krishna
  4. Mosoniro Kriina
  5. Santhiya V
  6. Lakshmi Krishnan
  7. Jayashree Kalva
  8. Maanasa Rajagopalan
  9. Prajitha Kannamkottapilly Chandrasekharan
  10. Vettrichelvan Venkatasamy
  11. Sonie Sait
  12. Jayashree S
  13. Sugavathy S
  14. Sailaja Bitragunta
  15. Meenakshi Sharma
  16. Roopa Shivashankar
  17. Pragati Pragya
  18. Sampada D Bangar
  19. Tapas Chakma
  20. Abhishek Kunwar
  21. Amol Wankhede
  22. Rupali Bharadwaj
  23. Vishwajit Bharadwaj
  24. Sravan Kumar Reddy T
  25. Navneet Kishore
  26. Bidisha Das
  27. Yannick Puthussery
  28. Deenadayalan Chandran
  29. Branch Immanuvel A
  30. Sandeep S Gill
  31. Ashu Gupta
  32. Bipin Gopal
  33. Ramakrishna K
  34. Jagannath Reddy M
  35. Sarita Hazare
  36. Namita Neelkanth
  37. Gagandeep Singh Grover
  38. Anupam Khungar Pathni
  39. Ganeshkumar Parasuraman
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Abstract

The India Hypertension Control Initiative (IHCI) aimed to strengthen public sector primary care for hypertension treatment and control. Our study describes changes in health-seeking behavior, prescription practices, and key predictors influencing treatment adoption in the public sector using data from IHCI repeat cross-sectional surveys. We conducted baseline (2018-19) and follow-up (2023-24) surveys in nine districts across five Phase I states in India - two districts each from Punjab, Madhya Pradesh, Telangana, and Kerala, and one from Maharashtra. The study planned to include 3,900 adults (18–69 years) diagnosed with hypertension and on treatment. We computed frequencies and proportions for socio-demographic variables, healthcare utilization, blood pressure (BP) control, drug availability, medication costs, and prescription practices. We used a log-binomial model to estimate unadjusted and adjusted prevalence ratios (PRs, APRs) with 95% confidence intervals for factors influencing care-seeking for hypertension in government facilities. Among 2,873 baseline and 3,276 follow-up respondents, the proportion seeking treatment at government facilities increased from 20–32%. Individuals on treatment were 1.5 times more likely to use government facilities in 2023-24 than in 2018-19 (aPR 1.54, 95% CI: 1.4–1.7). BP control improved in government (37–48%) and non-government (35–47%) facilities. Drug availability (always available) in government facilities rose from 72% (425/588) to 81% (844/1041), with Amlodipine 5mg remaining the most prescribed drug (18%). The proportion of individuals paying for medications dropped from 47–9%. There was an increase in public sector use, improved BP control, enhanced drug availability, and reduced costs, possibly due to IHCI interventions. We recommend using representative surveys for NCD surveillance to monitor healthcare utilization patterns and assess the impact of interventions on hypertension outcomes.

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  1. Version published to 10.21203/rs.3.rs-6801552/v1 on Research Square