title: Factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension.
abstract: BACKGROUND
  Missed appointments are associated with an increased risk of hospitalization and mortality. Despite its widespread prevalence, little data exists regarding factors related to appointment non-adherence among hypertensive African-Americans.
  
  
  OBJECTIVE
  To investigate factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension.
  
  
  METHODS
  A cross-sectional survey of 185 African-Americans admitted to an urban medical center in Maryland, with severe, poorly controlled hypertension from 1999-2004. Categorical and continuous variables were compared using chi-square and t-tests. Adjusted multivariable logistic regression was used to assess correlates of appointment non-adherence.
  
  
  METHODS
  Appointment non-adherence was the primary outcome and was defined as patient-report of missing greater than 3 appointments out of 10 during their lifetime.
  
  
  RESULTS
  Twenty percent of participants (n = 37) reported missing more than 30% of their appointments. Patient characteristics independently associated with a higher odds of appointment non-adherence included not finishing high school (Odds ratio [OR]  = 3.23 95% confidence interval [CI] (1.33-7.69), hypertension knowledge ([OR]  = 1.20 95% CI: 1.01-1.42), lack of insurance ([OR]  = 6.02 95% CI: 1.83-19.88), insurance with no medication coverage ([OR]  = 5.08 95% CI: 1.05-24.63), cost of discharge medications ([OR]  = 1.20 95% CI: 1.01-1.42), belief that anti-hypertensive medications do not work ([OR]  = 3.67 95% CI: 1.16-11.7), experience of side effects ([OR]  = 3.63 95% CI: 1.24-10.62), medication non-adherence ([OR]  = 11.31 95% CI: 3.87-33.10). Substance abuse was not associated with appointment non-adherence ([OR]  = 1.05 95% CI: 0.43-2.57).
  
  
  CONCLUSIONS
  Appointment non-adherence among African-Americans with poorly controlled hypertension was associated with many markers of inadequate access to healthcare, knowledge, attitudes and beliefs.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America.
authors.forename: Chike C
authors.initials: CC
authors.lastname: Nwabuo
authors.affiliation: Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, MD, United States of America.
authors.forename: Sydney Morss
authors.initials: SM
authors.lastname: Dy
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America.
authors.forename: Kristina
authors.initials: K
authors.lastname: Weeks
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America; Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, United States of America.
authors.forename: J Hunter
authors.initials: JH
authors.lastname: Young
mesh_terms: D001741:Black or African American; D001071:Appointments and Schedules; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010349:Patient Compliance