Continuity of Care and the Control of High Blood Pressure at Colombian Primary Care Services.

ABSTRACT

Continuity of care (COC) has been associated with lower mortality and hospitalizations and higher high blood pressure (HBP) control rates. This evidence mainly came from high income countries. We aimed to identify conditions associated with controlled HBP, particularly COC, in primary care services (PCSs) affiliated to two health insurances in Colombia, a low-median income country. A longitudinal observational study was carried out using clinical records of hypertensive adults >18 years with ≥4 clinic visits attending a contributive and a subsidized PCS in Cali (Colombia) between 2013 and 2014. Subsidized PCSs were for unemployment people and those at low socio-economic position and contributive for formal workers. COC was measured using the Bice and Boxerman index. Logistic regression models were performed to quantify the relation between COC and controlled HBP (blood pressure <140/90 mmHg). Between 2013 and 2014, among 8797 hypertensive people identified, 1358 were included 935 (68.8%) and 423 (31.1%) from the contributive and subsidized PCSs, respectively. 856 (62.3%) were women and had a mean age of 67.7 years (SD 11.7). All people were on antihypertensive treatment. Over the study period, 522 (38.4%) people had controlled HBP, 410 (43.9%) in the contributive and 112 (26.5%) in subsidized PCSs. An increase in 1 unit of the COC index is associated with a 161% higher probability of having HBP controlled (OR, 2.61; 95% CI, 1.25-5.44). The odds of having controlled HBP increased as the number of visits rose; for example, people at the fourth visit had a 34% (OR, 1.34; 95% CI, 1.08-1.66) higher probability of reaching the target. Continuity of care was positively associated with controlled HBP. The strengthening of COC can improve the observed low HBP control rates and reduce health inequalities.