Treatment Outcomes of Patients with Hypertension at Buriram Hospital

Abstract

Ministry of Public Health, Thailand implements the rational drug use policy and sets the process indicators of prescribing in targeted diseases including hypertension. This study aimed to examine treatment outcomes of patients with hypertension at Buriram hospital under the rational drug use policy. Methods: Secondary data analysis of patients who continually visited and received treatment at Buriram hospital was conducted using hospital database during 2012 and 2017.  Appropriate descriptive statistics were used for situation analysis and logistic regression analysis was used to analyze factors associated with hospitalization with hypertension in 2017. Results: Numbers of patients with hypertension increased every year during 2012 and 2017 (from 14,245to 20,306 patients). In 2017, an average age of patients with hypertension was 64 ± 13.37 years. One third of these patients (33.0%) were in age group 40 - 60 years and 63.1% of them were elderly group (age > 60 years). Proportion of female was more than male (1.2:1). Majority of patients (62.5%) were patients within the catchment area of Buriram hospital. Number of patients under the Universal Health Coverage Scheme was more than those in Social Security Benefit Scheme and Civil Servant Medical Benefit Scheme (12.4:1:5). Major comorbidities included diabetes mellitus, chronic kidney disease, hemorrhagic stroke, heart failure, and myocardial infarction (29.0, 16.0, 8.5, 2.8, and 2.1%, respectively). The percent of uncontrolled hypertension was 25.8%. Percentages of hospitalization with principle diagnosis of hypertension among patients with controlled hypertension during 2012 and 2017 were 1.11, 1.79, 1.48, 1.62, 1.29 and 1.47%, respectively whereas those with uncontrolled hypertension were 4.27, 4.15, 3.73, 3.68, 3.92 and 3.41%, respectively. Controlled hypertension was factor associated with decreasing of hospitalization (Odds ratio (OR): 0.57; 95% confidence interval (CI): 0.38, 0.83; p = 0.004). Comorbidities that were significantly increased risk of hospitalization included chronic kidney disease (OR: 2.00; 95%CI: 1.33, 3.03; p = 0.001), hemorrhagic stroke (OR: 4.13; 95%CI: 2.58, 6.62; p < 0.001), heart failure (OR: 21.86; 95%CI: 14.01, 34.12; p < 0.001), and myocardial infarction (OR: 65.85; 95%CI: 37.75, 114.86; p < 0.001). Conclusion: Numbers of patients with hypertension are increasing. Patients with controlled hypertension had lower numbers of hospitalizations than those with uncontrolled hypertension. An increased risk of hospitalization was found in patients with comorbidities including chronic kidney disease, hemorrhagic stroke, heart failure, and myocardial infarction compared to those without these comorbidities.