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Factors Associated with Appointment Non-Adherence among African-Americans with Severe, Poorly Controlled Hypertension

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  • Chike C Nwabuo
  • Sydney Morss Dy
  • Kristina Weeks
  • J Hunter Young

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.

Suggested Citation

  • Chike C Nwabuo & Sydney Morss Dy & Kristina Weeks & J Hunter Young, 2014. "Factors Associated with Appointment Non-Adherence among African-Americans with Severe, Poorly Controlled Hypertension," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-7, August.
    • Handle: RePEc:plo:pone00:0103090
    DOI: 10.1371/journal.pone.0103090
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    References listed on IDEAS

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    1. Christopher J L Murray & Sandeep C Kulkarni & Catherine Michaud & Niels Tomijima & Maria T Bulzacchelli & Terrell J Iandiorio & Majid Ezzati, 2006. "Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States," PLOS Medicine, Public Library of Science, vol. 3(9), pages 1-12, September.
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