October 23, 2024: A new study by the Max Institute of Healthcare Management at the Indian School of Business (ISB) identifies critical lacunae in hypertension diagnosis and management by private healthcare providers, particularly in rural and peri-urban India. The findings underscore the need for a more standardised and structured healthcare approach to hypertension, a chronic condition affecting over 220 million Indians and the leading cause of cardio-vascular diseases.

Published in BMC Health Services Research, a peer-reviewed journal, the qualitative study titled ‘Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study’ involved in-depth interviews with over 46 primary healthcare professionals and patients across three districts of Telangana- Warangal Urban, Karimnagar, and Sircilla. Key findings point to inconsistent diagnostic practices, improper follow-up mechanisms and inadequate record-keeping, which hinder effective hypertension management.

A concerning revelation of the study is the lack of adherence to routine opportunistic screening protocols as private practitioners measure blood pressure only when patients exhibit explicit symptoms. Additionally, arbitrary variation in diagnostic thresholds by private practitioners further delays the diagnosis, leaving the patients devoid of treatment and at a heightened risk of complications. The evident human cost of these lapses underpins the importance of routine monitoring and timely detection.

Additionally, the study highlights the lack of consistent follow-up routine, pointing out that the high costs of diagnostic tests discourage the patients from seeing a specialist, stressing the need for financial aid to improve sustained long-term management of the disease.

Moreover, the lack of monitoring systems, poor record-keeping practices, and the absence of a structured follow-up mechanism hamper regular follow-up regime and treatment adherence, further compounding the crisis.

To improve the outcomes, the ISB-MIHM study recommends compliance to standardised screening protocols and targeted educational interventions to address knowledge gaps and attitudinal barriers among private practitioners as well as patient education for enhanced self-management. It also suggests innovative financing models such as insurance or community health funds to lessen the economic burden on patients by minimizing out-of-pocket expenditure. Alongside systematic follow-up mechanisms such as patient outreach, community participation and digital monitoring tools, these measures can augment treatment adherence and overall hypertension management.

“Hypertension is often considered a health issue primarily affecting the affluent urban populations, but its prevalence is rising among lower income groups in rural and peri-urban areas, where access to formal healthcare is limited. This makes it crucial to develop public health programs that engage with the healthcare providers at the local level to improve the quality of care and reduce the risk of complications,” said Professor Sarang Deo, Executive Director, Max Institute of Healthcare Management and one of the co-authors of the study.