Addressing Care Continuity and Quality Challenges in the Management of Hypertension: a Case Study of the Private Healthcare Sector in Kenya

Abstract

Background: Hypertension is the major risk factor of cardiovascular disease and a leading cause of morbidity and mortality worldwide. In Kenya, the rise of hypertension strains an already stretched healthcare system that has traditionally focused on the management of infectious diseases. Healthcare provision in this country remains fragmented and little is known about the role of health information technology in care coordination. Furthermore, there is a dearth of literature on the experiences, challenges, and solutions for improving the management of hypertension and other noncommunicable diseases in the Kenyan private healthcare sector. Objectives: The purpose of this study was (1) to assess stakeholder perspectives on the challenges associated with the management of hypertension in the Kenyan private healthcare sector, and (2) to derive recommendations for the design and functionality of a digital health solution for addressing the care continuity and quality challenges in the management of hypertension. Methods: We conducted a qualitative case study. We collected data using in-depth interviews with 18 care providers and 8 business leads as well as direct observations at 18 private healthcare institutions in Nairobi, Kenya. We analyzed the data thematically to identify the key challenges and recommendations for technology-enabled solutions for supporting the management of hypertension in the Kenyan private health sector. We subsequently used the generated insights to derive and describe the design and range of functions of a digital health wallet platform for enabling care quality and continuity. Results: The management of hypertension in the Kenyan private healthcare sector is characterized by challenges such as high cost of care, limited healthcare literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care providers lack the tools needed to understand their patient’s care histories and effectively coordinate efforts to deliver high-quality hypertension care. The proposed digital health platform was designed to support hypertension care coordination and continuity through clinical workflow orchestration, decision-support, and patient-mediated data sharing with privacy-preservation, auditability, and trust enabled by blockchain technology. Conclusions: The Kenyan private healthcare sector faces key challenges that require significant policy, organizational, and infrastructural changes to ensure care quality and continuity in the management of hypertension. Digital health data interoperability solutions are needed to improve hypertension care coordination in the sector. Additional studies should investigate how patients can control the sharing of their data while ensuring care providers have a holistic view of the patient during any encounter.