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Estimation of the global gap in clinic visits for hypertension care between patient need and physician capacity

Neupane D, Gao Y, Feng Y, Matsushita K and Appel L

In most countries, only physicians are allowed to prescribe antihypertensive medication. Thus, physician capacity (number of physician clinic visits available for hypertension care) is a critical determinant of hypertension control. This study estimates the global gap between physician capacity and patient need. We used World Health Organization and World Bank data and assumed that on average a physician conducts 5000 clinic visits/year (base scenario), with 10% time spent on hypertension care. For high-capacity scenarios, we assumed 10 000 visits/year. We estimated the effects of different numbers of physician visits/y per patient: 12 (common in low and middle-income countries for monthly prescription refills), 6, and 3 annual visits. At 12 visits/year, most countries have a deficit in physician capacity. Even assuming 6 visits/year, the deficit in most African and South Asian countries still exists. At 3 visits/year, a gap persists in 69% of lower middle income countries and 89% of low-income countries. Assuming 3 visits/year per patient, the countries with the highest visit gaps are India at 73 million visits/year, Indonesia at 62 million visits/year, and Ethiopia at 30 million visits/year. Even in the high-capacity scenario, 50% of lower middle income countries and 86% of low-income countries have a physician capacity deficit. Even under plausible scenarios of 6 or 3 visits/year, a substantial deficit in physician capacity to provide hypertension care exists in many low and middle-income countries. To increase hypertension control globally, countries need to enact changes to their health systems and policies that promote task-sharing and that allow multi-month prescription refills.