Factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension

Abstract

Background: Missed appointments are associated with an increased risk of hospitalization and mortality. Despite its widespread prevalence, little data exists regarding factors related to appointment non-adherence among hypertensive African-Americans. Objective: To investigate factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension. Design and Participants: A cross-sectional survey of 185 African-Americans admitted to an urban medical center in Maryland, with severe, poorly controlled hypertension from 1999-2004. Categorical and continuous variables were compared using chi-square and t-tests. Adjusted multivariable logistic regression was used to assess correlates of appointment non-adherence. Main Outcome Measures: Appointment non-adherence was the primary outcome and was defined as patient-report of missing greater than 3 appointments out of 10 during their lifetime. Results: Twenty percent of participants (n = 37) reported missing more than 30% of their appointments. Patient characteristics independently associated with a higher odds of appointment non-adherence included not finishing high school (Odds ratio [OR] = 3.23 95% confidence interval [CI] (1.33-7.69), hypertension knowledge ([OR] = 1.20 95% CI: 1.01-1.42), lack of insurance ([OR] = 6.02 95% CI: 1.83-19.88), insurance with no medication coverage ([OR] = 5.08 95% CI: 1.05-24.63), cost of discharge medications ([OR] = 1.20 95% CI: 1.01-1.42), belief that anti-hypertensive medications do not work ([OR] = 3.67 95% CI: 1.16-11.7), experience of side effects ([OR] = 3.63 95% CI: 1.24-10.62), medication non-adherence ([OR] = 11.31 95% CI: 3.87-33.10). Substance abuse was not associated with appointment non-adherence ([OR] = 1.05 95% CI: 0.43-2.57). Conclusions: Appointment non-adherence among African-Americans with poorly controlled hypertension was associated with many markers of inadequate access to healthcare, knowledge, attitudes and beliefs. © 2014 Nwabuo et al.