Table 2.
Barriers and facilitators to prescribing for doctors in high- and upper-middle income or lower-middle and low-income countries.
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| STATEMENTS ABOUT BARRIERS AND FACILITATORS TO PRESCRIBING FIXED-DOSE COMBINATION ANTIHYPERTENSIVE MEDICATIONS FOR THE CONTROL OF HYPERTENSION | ALL (INCLUDING DATA WHERE COUNTRY OF WORK WAS NOT AVAILABLE) n = 179 | HIGHER INCOME n = 120 | LOWER INCOME n = 59 | STANDARDIZED MEAN DIFFERENCE (BETWEEN HIGHER AND LOWER INCOME COUNTRIES) | 95% CONFIDENCE INTERVAL |
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Appointment Time You have insufficient time during consultations to explain medication changes to the patient. | |||||
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| Strongly disagree | 35 (20%) | 23 (19%) | 12 (20%) | 0.01 | –0.30 to 0.32 |
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| Disagree | 61 (34%) | 39 (32%) | 22 (37%) | ||
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| Neither disagree nor agree | 21 (12%) | 18 (15%) | 3 (5%) | ||
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| Agree | 55 (31%) | 36 (30%) | 19 (32%) | ||
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| Strongly agree | 7 (4%) | 4 (3%) | 3 (5%) | ||
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Access Your patients do not have access to fixed-dose combination antihypertensive medications where you work. | |||||
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| Strongly disagree | 57 (32%) | 34 (28%) | 23 (39%) | 0.08 | –0.23 to 0.39 |
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| Disagree | 40 (22%) | 28 (23%0 | 12 (20%) | ||
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| Neither disagree nor agree | 15 (8%) | 13 (11%) | 2 (3%) | ||
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| Agree | 38 (21%) | 28 (23%) | 10 (17%) | ||
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| Strongly agree | 29 (16%) | 17 (14%) | 12 (20%) | ||
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Confidence in clinic BP measurement You do not trust blood pressure measurements taken in the clinic setting. | |||||
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| Strongly disagree | 34 (19%) | 22 (18%) | 12 (20%) | 0.14 | –0.17 to 0.45 |
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| Disagree | 47 (26%) | 29 (24%) | 18 (31%) | ||
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| Neither disagree nor agree | 28 (16%) | 21 (18%) | 7 (12%) | ||
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| Agree | 62 (35%) | 41 (34%) | 21 (36%) | ||
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| Strongly agree | 8 (5%) | 7 (6%) | 1 (2%) | ||
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Cost to the medical practice Fixed-dose combination antihypertensive medications are too expensive for your medical practice to support. | |||||
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| Strongly disagree | 23 (13%) | 18 (16%) | 5 (9%) | 0.07 | –0.24 to 0.39 |
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| Disagree | 42 (25%) | 23 (20%) | 19 (33%) | ||
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| Neither disagree nor agree | 19 (11%) | 13 (11%) | 6 (11%) | ||
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| Agree | 60 (35%) | 40 (35%) | 20 (35%) | ||
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| Strongly agree | 27 (16%) | 23 (18%) | 7 (12%) | ||
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Side effects Your patients are concerned about experiencing more adverse events (for example, dizziness, headache) when taking fixed-dose combination antihypertensive medications compared to adding medicines sequentially. | |||||
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| Strongly disagree | 30 (17%) | 19 (16%) | 11 (19%) | –0.32 | –0.64 to –0.01 |
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| Disagree | 68 (38%) | 52 (43%) | 16 (27%) | ||
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| Neither disagree nor agree | 44 (25%) | 32 (27%) | 12 (20%) | ||
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| Agree | 31 (17%) | 15 (12%) | 16 (27%) | ||
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| Strongly agree | 6 (4%) | 2 (2%) | 4 (7%) | ||
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Adherence You are concerned your patients will not adhere to the fixed-dose combination medication regimen. | |||||
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| Strongly disagree | 71 (40%) | 47 (39%) | 24 (41%) | –0.06 | –0.37 to 0.25 |
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| Disagree | 72 (40%) | 48 (40%) | 24 (41%) | ||
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| Neither disagree nor agree | 15 (9%) | 12 (10%) | 3 (5%) | ||
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| Agree | 15 (9%) | 12 (10%) | 3 (5%) | ||
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| Strongly agree | 6 (3%) | 1 (1%) | 5 (9%) | ||
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Clinician nudge A clinician nudge that provides a prompt in the electronic health record during the patient visit to prescribe fixed-dose combination antihypertensive medications would support the prescription of those medications. | |||||
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| Strongly disagree | 8 (5%) | 8 (7%) | 0 | –0.13 | –.44 to 0.19 |
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| Disagree | 15 (8%) | 11 (9%) | 4 (7%) | ||
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| Neither disagree nor agree | 47 (26%) | 27 (22%) | 20 (34%) | ||
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| Agree | 80 (45%) | 54 (45%) | 26 (44%) | ||
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| Strongly agree | 29 (16%) | 20 (17%) | 9 (15%) | ||
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Education Providing education and feedback on prescribing patterns compared with peers focusing on fixed-dose combination antihypertensive medications would support the prescription of those medications. | |||||
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| Strongly disagree | 9 (5%) | 6 (5%) | 3 (5%) | 0.01 | –0.30 to 0.33 |
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| Disagree | 10 (6%) | 6 (5%) | 4 (7%) | ||
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| Neither disagree nor agree | 17 (10%) | 11 (9%) | 6 (10%) | ||
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| Agree | 59 (33%) | 42 (35%) | 17 (29%) | ||
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| Strongly agree | 84 (46%) | 55 (46%) | 29 (49%) | ||
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Additional BP measures data Having access to data from remote monitoring devices such as smartwatches would support the prescription of fixed-dose combination antihypertensive medications. | |||||
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| Strongly disagree | 9 (5%) | 6 (5%) | 3 (5%) | 0.23 | –0.08 to 0.55 |
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| Disagree | 24 (13%) | 13 (11%) | 11 (19%) | ||
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| Neither disagree nor agree | 16 (15%) | 18 (15%) | 8 (14%) | ||
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| Agree | 79 (44%) | 51 (42%) | 28 (47%) | ||
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| Strongly agree | 41 (23%) | 32 (27%) | 9 (15%) | ||
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Health literacy Patient information such as leaflets and flyers in clinics focusing on fixed-dose combination antihypertensive medications would support the prescription of those medications. | |||||
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| Strongly disagree | 18 (10%) | 12 (10%) | 6 (10%) | 0.03 | –0.29 to 0.34 |
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| Disagree | 22 (12%) | 15 (12%) | 7 (12%) | ||
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| Neither disagree nor agree | 51 (28%) | 34 (28%) | 17 (29%) | ||
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| Agree | 66 (37%) | 43 (36%) | 23 (39%) | ||
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| Strongly agree | 22 (12%) | 16 (13%) | 6 (10%) | ||
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