Assessment of cardiovascular risk and target organ damage among adult patients with primary hypertension in Thika Level 5 Hospital, Kenya: a criteria-based clinical audit

Abstract

In Thika Level 5 Hospital, audit and feedback has a poor impact on assessment of cardiovascular risk and target organ damage but positive impact on blood pressure control and prescription practices. Time and sample size may have affected observed results. Additional audits and alternative QI strategies are warranted.

Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action

“…Eleven published (55%) and nine unpublished reports (45%) of implementation projects undertaken in Africa were reviewed. The majority of projects were conducted in Kenya (Amdamy & McMillan, ; Kaguongo & McArthur, ; Karua, ; Kebaya et al, ; Mirigo, ; Mwita et al, ; Nyakiba et al, ; Panga et al, ), Ghana (Amoah et al, ; Bayuo et al, ; Oduro, ; Tinkorang et al, ), Ethiopia (Admassu et al, ; Feyissa et al, ; Kerie et al, ), and Uganda (Ayiasi et al, ; Muhumuza et al, ), with one project each from Malawi (Chibwana & Gomersall, ), Tanzania (Jelly & Peters, ), and Cameroon (Okwen et al, ). A third of the projects were undertaken in a teaching hospital ( n = 6/20, 30%), another third were conducted in a regional, rural, district or public hospital ( n = 7, 35%), a few were carried out in a paediatric hospital ( n = 3, 15%), and one project each was implemented in a health centre ( n = 1, 5%), infectious disease hospital ( n = 1, 5%), health district ( n = 1, 5%) and a university‐based dental clinic ( n = 1, 5%).…”

“…The most frequently identified barrier that traversed countries and clinical settings was lack of material resources ( n = 16/20; 80%), including hospital equipment (e.g., endoscope, safety devices for sharp objects, ultrasound machine), supplies (e.g., hand hygiene products, water supply, sterile packs, medications), assessment tools (e.g., cardiovascular risk screening tool, pain assessment, thermometers) and reporting or documentation forms (Admassu, Abdulahi, Fogi, & Egziabher, ; Amdamy & McMillan, ; Amoah, Moola, & Newman‐Nartey, ; Bayuo et al., ; Chibwana & Gomersall, ; Feyissa, Gomersall, & Robertson‐Malt, ; Kaguongo & McArthur, ; Karua, ; Mirigo, ; Muhumuza et al., ; Mwita, Ogoti, Abila, Mbogo, & Sisenda, ; Nyakiba, McMillan, & Kenyatta, ; Oduro, ; Okwen et al., ; Panga et al., ; Tinkorang et al., ). An implementation project undertaken in a paediatric hospital in Kenya, which aimed to improve pain assessment in children postsurgery, identified the lack of an acute pain service (including a team of skilled practitioners and a dedicated facilitator to lead the service) as a key barrier to the implementation of best practice in acute postoperative pain assessment and management in children (Panga et al., ).…”

“…Another commonly reported organizational barrier was related to human resources ( n = 9/20; 45%). Heavy workload or inadequate staffing was identified in projects conducted in Uganda, Kenya, Ghana and Ethiopia across various clinical areas and was frequently described in rural‐ or regional‐based settings (Admassu et al., ; Amdamy & McMillan, ; Ayiasi et al., ; Feyissa et al., ; Karua, ; Mirigo, ; Muhumuza et al., ; Mwita et al., ; Oduro, ). Lack of or inadequate supervision and oversight of services provided to patients (i.e., postnatal women and patients postpulpotomy) was identified by two projects undertaken in Uganda and Ghana, respectively (Amoah et al., ; Ayiasi et al., ).…”

“…Lack of knowledge, misconceptions about EBHC and lack of access to best practice recommendations were the most frequently cited barriers ( n = 14/20; 70%) at the health practitioner level, across all countries and clinical settings (Amdamy & McMillan, ; Bayuo et al., ; Chibwana & Gomersall, ; Feyissa et al., ; Jelly & Peters, ; Kaguongo & McArthur, ; Karua, ; Mirigo, ; Muhumuza et al., ; Mwita et al., ; Oduro, ; Okwen et al., ; Panga et al., ; Tinkorang et al., ). This barrier was attributed to lack of resources to enable access to evidence‐based/best practice recommendations, lack of available professional development training and lack of time to attend training.…”

A Retrospective Five-Year Study of Cardiovascular Risk Assessment and Risk-Based Interventions Among Hypertensive Patients in Nairobi Hospital, Kenya

“…In Kenya, a high burden of cardiovascular risk factors was demonstrated by the WHO STEPs survey which revealed that the majority of the adult population (75.6%) had four to six risk factors for CVD while 10% had seven or more CVD risk factors [ 3 ]. Despite the high prevalence of risk factors, an initial audit in Kenya among general practitioners at a public hospital in 2013 found zero uptake of CVD risk assessment with a follow-up audit among the same cohort of health workers five months later revealing no improvement in uptake of CVD risk assessment despite strategies to encourage its use [ 4 ].…”