Health System Competence and Care Continuity in Patients with Hypertension: Electronic Cohort in Uruguay.

BACKGROUND: Despite efforts to improve hypertension management, control rates remain low. Effective control depends on care competence and continuity. Using an innovative and scalable tool, the electronic cohort, we aimed to describe health system competence, care continuity, user experience, and health and economic outcomes among individuals with hypertension in Uruguay. METHODS: A longitudinal follow-up of patients with hypertension was conducted in Uruguay. A population-based sample was selected through multistage random sampling from a pre-existing cohort (CESCAS 2010). It included 200 adults (≥35 years) with known diagnosis and/or blood pressure >140/90 mmHg at baseline and access to a mobile phone. Participants were followed for eight months using three structured surveys: a baseline in-person survey, six telephone follow-ups, and a final in-person survey. These documented health status, health system competence, care continuity, patient activation, user experience, and health and economic outcomes. RESULTS: Mean age was 64.9 (9.7) years; 77% reported "Excellent/Very good" health. Overall, 79.5% were aware of their hypertension and on treatment; 42.0% of the total sample had controlled blood pressure at baseline. Only 11.5% received all recommended clinical interventions per national guidelines. Regardless of coverage, 60.8% usually attended a primary care facility. 93.5% attended at least one visit in 8 months, but only 48.8% of newly diagnosed participants (those with blood pressure >140/90 mmHg at baseline and not taking medication) completed the three recommended visits. 57.1% received care from the same professional in the same facility. Blood pressure control was achieved by 34.4% of those with known hypertension and 19.5% of newly diagnosed participants. 49% reported that medical appointments were available when needed. Patient activation was 70.5%, and 68.9% reported autonomy in decision-making. CONCLUSION: The low proportion of individuals receiving continuous, competent care, particularly among those newly diagnosed, underscores the need for targeted interventions to improve care quality.