Relationship between proxy behavior in clinic attendance and disease control among persons with hypertension and diabetes at a rural primary health center: A cohort analysis in South India.

Aims: Among persons with hypertension and diabetes on treatment for at least 1 year at the Rural Health Centre (RHC) noncommunicable disease (NCD) clinic, 1. To determine the control status for hypertension and diabetes. 2. To assess the relationship between proxy behavior for collection of medications and the control status.

Settings and design: Rural Health Centre, Ramanathapuram, Puducherry, India; record-based retrospective observational study.

Methods and material: The study employed a universal sampling of 396 eligible persons with diabetes and hypertension who had been on medication for over a year at the RHC NCD clinic and had recorded blood pressure and glucose values within the last 4 months. Case sheets of these patients were retrieved from the Medical Registration Department, and data from the past 12 months were collected and analyzed to assess proxy behaviors and absenteeism.

Statistical analysis used: Data were entered from the case sheets in Epicollect5 and analyzed using Stata v17.

Results: Among hypertensive patients, 48.01% were aged 60 and above, with 55.63% being female. Fifty-six percent of hypertensive patients had their condition controlled. For diabetic patients, 40.88% were aged 45-59 years, with 59.75% being female. Only 18.24% of diabetic patients had their condition controlled. The multivariable analysis examined factors associated with the control status of hypertension and diabetes. Those aged 30-44 (aRR: 1.47, 95% CI: 1.01-2.15) and 45-59 (aRR: 1.37, 95% CI: 1.03-1.82) had a higher risk of uncontrolled hypertension compared to those aged 60 and above. Gender did not show significant associations with hypertension control status. Regarding attendance status, patients who had both proxy and missed visits (RR: 1.46, 95% CI: 1.02-2.07) had a higher risk of uncontrolled hypertension. There was also a significant association with patients having more than three proxies (aRR: 1.51, 95% CI: 1.10-2.17) exhibiting a higher risk of uncontrolled hypertension. Absenteeism status showed that those absent for 1-3 visits had a higher relative risk (RR: 1.37, 95% CI: 1.03-1.82) of uncontrolled hypertension compared to those with no absenteeism.

Conclusion: Proxy behavior affects the control status of persons with hypertension and diabetes. A longitudinal study is warranted to assess the relationship between proxy visits and control status.