Quality (343) Evidence for an expanded hypertension care cascade in low- and middle-income countries: a scoping review

30 June, 2022

Dear HIFA colleagues

(with thanks to Shams Syed, WHO)

CITATION: BMC Health Serv Res

2022 Jun 27;22(1):827. doi: 10.1186/s12913-022-08190-0.

Evidence for an expanded hypertension care cascade in low- and middle-income countries: a scoping review

Michael A Peters et al. DOI: 10.1186/s12913-022-08190-0

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-0...

ABSTRACT

Background: With nearly 90% of annual hypertension-related deaths occurring in low- and middle-income countries (LMICs), there is an urgent need to measure the coverage of health services that effectively manage hypertension. However, there is little agreement on how to define effective coverage and the existing hypertension care cascade (hypertension prevalence, percent aware, percent treated, and percent controlled) does not account for the quality of care received by patients. This study reviews definitions of effective coverage and service quality for hypertension management services and proposes an expanded hypertension care cascade to improve measurement of health systems performance.

Methods: A systematic scoping review of literature published in six electronic databases between January 2000 and October 2020 identified studies that defined effective coverage of hypertension management services or integrated dimensions of service quality into population-based estimates of hypertension management in LMICs. Findings informed an expanded hypertension care cascade from which quality-adjusted service coverage can be calculated to approximate effective coverage.

Results: The review identified 18 relevant studies, including 6 that defined effective coverage for hypertension management services and 12 that reported a measure of service quality in a population-based study. Based on commonly reported barriers to hypertension management, new steps on the proposed expanded care cascade include (i) population screened, (ii) population linked to quality care, and (iii) population adhering to prescribed treatment.

Conclusion: There is little consensus on the definition of effective coverage of hypertension management services, and most studies do not describe the quality of hypertension management services provided to populations. Incorporating aspects of service quality to the hypertension care cascade allows for the calculation of quality-adjusted coverage of relevant services, enabling an appropriate measurement of health systems performance through effective coverage.

SELECTED EXTRACT: 'To ensure consistency in future reporting of effective coverage of hypertension management, it will be important to incorporate perspectives of patients, researchers, and policymakers from multiple contexts when agreeing on international guidelines.'

COMMENT (NPW): HIFA stands ready to help explore the above issues (whether for hypertension or other health priorities) and to help elicit 'perspectives of patients, researchers, and policymakers from multiple contexts when agreeing on international guidelines'.

Best wishes, Neil

Coordinator, WHO-HIFA project on Learning for Quality Health Services

https://www.hifa.org/projects/learning-quality-health-services

Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org

Working in official relations with WHO