Hypertension Cascade Across Three Healthcare Systems and in Relation to the Level of Implementation of the Integrated Care Package

Introduction: We built Cascades of Care (CoC) for hypertension in Belgium, Slovenia
and Cambodia, and assessed CoC stratifications across patients’ gender and
socioeconomic status. Differences between the CoCs were studied by looking at the
level of implementation of the integrated care package and other health system
characteristics.
Methods: A mixed methods design: Age-standardized gender-specific hypertension
cascades were built from survey and register data and logistic regression analyses
were performed. Focus group discussions with experts were used to interpret these
results.
Results: In Belgium, the largest gap is between ‘prevalence’ and ‘diagnosis’. In
Cambodia, a large drop –especially among men– is found at the beginning and the end
of the cascade. In Slovenia, only a limited number of patients is tested and linked to
care, but once registered, attrition is quite low. Poor financial situation was a significant
determinant of drop-out across the countries but at different stages of the CoC, and
especially in Cambodia large gender differences were observed with women being
better retained throughout the CoC.
Discussion and conclusion: Despite contextual differences between the countries and
difficulties in comparability of the cascades, lessons can be learnt from each country’s
strengths and weaknesses to improve quality of integrated hypertension care