Are doctors assessing patients with hypertension appropriately at their initial presentation?

Abstract

INTRODUCTIONThe aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients' first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period. METHODSThis retrospective study was conducted between January and May 2012. Data was extracted from the paperbased medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient's first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit.RESULTS A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%-40.8%). Assessments for a history of TOD were found in only 5.8%-11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%-63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered. CONCLUSIONThere was poor assessment of the patients' CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations.

Quality of hypertension management in public primary care clinics in Malaysia: An update

“…The process of care remains deficient with gaps in guidelines and actual clinical practice. These suboptimal BP control and hypertensive management findings were consistent with several local cross-sectional surveys and clinical audits on hypertension management conducted in primary care [7,9,11,17,21,22,28,30]. These consistent findings as previous studies demonstrated that the hypertensive care in Malaysia still remains much as it was in the past decade.…”

“…Those without anti-hypertensive agents prescribed but with a diagnosis of hypertension were considered to be on lifestyle modification. The process of care and the prescribing practices that were not documented will be interpreted as "not done" even though the patient may indeed receive the care in actuality [17].…”

“…was an increasing trend in the percentage of documented investigations conducted for evaluation of hypertension during a patient's first clinic visit from 1998 to 2012 [17]. Apart from this, the Malaysian Statistics on Medicines report revealed that there was substantial increase in utilisation pattern of certain antihypertensive classes in the public primary care clinics [25].…”

Universal Coverage of Hypertension Treatment Services in Malaysia Is Still an Elusive Goal

“…25 However, there is some evidence to suggest that some doctors may not have adhered to the CPG that could have an effect on patients' clinical outcomes. [34][35][36] In addition, there is some evidence to suggest that patients themselves may not fully adhere to prescribed medications. A national survey conducted in 2012 showed that 42% of the adults surveyed admitted to have consciously chosen not to take medicines prescribed to them.…”

Study protocol on Enhanced Primary Healthcare (EnPHC) interventions: a quasi-experimental controlled study on diabetes and hypertension management in primary healthcare clinics

“…Second, for hypertension, 1760 patient visits (880 in each arm) were needed to have 80% power to detect a 28% relative change in the proportion of hypertension patients with at least one lipid profile from the baseline proportion of 46% (Wong et al, 2015). This calculation took into account the estimated clustering of this outcome at the clinic level (ICC = 0.076) (Singh et al, 2015).…”