Use of health care services associated with blood pressure management in hypertensive patients: a longitudinal analysis comparing natives and African immigrants

Abstract

Introduction: Ethnic and cultural diversity in Portugal has reinforced the importance of adjusting healthcare services to the health needs of different populations. This study aims to analyse longitudinally the factors associated with health care use by native Portuguese and African hypersive patients. Methods: Longitudinal study including treated hypertensive patients followed-up in primary care in the Lisbon region, between September 2010 and March 2012. For this analysis, 233 native Caucasians and 170 African immigrants were included. We applied three face-to-face questionnaires (0, 6 and 12 months) and two by telephone (3 and 9 months). The measure of service use was the number of encounters due to hypertension, in the three months preceding the interview. For the identification of the factors, a longitudinal generalised linear mixed model was estimated for each group. Results: More natives than immigrants consulted the GP in the last year (76.0% vs 64.7%, p=0.019), however, more immigrants used urgent health care (12.4% vs 5.2%, p=0.016). The proportion of patients with at least one medical encounter was not different between groups (46.5% vs 41.6%, p=0.387). After adjusting for all variables, the use of medical care among natives was associated with age (eβ=1.036; p=0.021), diabetes (eβ=1.898; p=0.006), hypertension control (eβ=1.036; p=0.007), uncontrolled self-assessed hypertension status (eβ=0.596; p=0.033), and follow-up time. (eβ=0.771; p=0.001). Among immigrants, the use of health services was associated with marital status (eβ=2.228; p=0.025), uncontrolled self-assessed hypertension status (eβ=0.580; p=0.013), time since diagnosis of hypertension (eβ=1.021; p=0.016) and follow-up time (eβ=0.689; p<0.001). Conclusions: There is a need to better understand the differences in the factors associated with the use of hypertension-related health care among natives and immigrants, in order to develop health promotion strategies adapted to target populations.