The chronic disease passport: an assessment of its effectiveness in improving hypertension control in Jamaicans

ABSTRACT

OBJECTIVE: To assess whether the Chronic Disease Passport (CDP) was effective in improving blood pressure control in patients in Montego Bay, Jamaica. DESIGN AND METHODS: A retrospective cohort study was conducted on a convenient sample of 264 patients aged 18-74 years with hypertension (HPT) who attended the Type 5 Health Centre in Montego Bay between May and July 2014. Blood pressure control was assessed at baseline and one year post exposure, using data from medical records. Knowledge, attitude and behaviour towards HPT and the CDP were gathered through an interviewer-administered questionnaire. In-depth semi-structured interviews were conducted with 6 persons who had received the CDP. RESULTS: Seventy-seven percent of respondents (n=204) were exposed to the CDP. At baseline HPT control was significantly better in the exposed group (20.7%), versus the non-exposed group (5.0%) (p<0.01). At the one year follow-up endpoint, there was no significant association between exposure to the CDP and HPT control with the relative risk of having a controlled SBP being significantly lower in the exposed group (RR = 0.44, 95% CI 0.24, 0.81). Control of HPT among the exposed group also worsened by 17.3% (p<0.001), but remained unchanged for the non-exposed group. Participants cited medication supply as an issue of concern. CONCLUSION: Exposure to the CDP was not associated with better control of HPT. More research is needed to explore other impacting factors, including issues surrounding medication supply.