Hypertension and diabetes: Poor care for patients at community health centres

Abstract

ArticlEObjectives. To identify health care provider-related determinants of diabetes and hypertension management in patients attending public sector community health centres (CHCs). Methods.A random sample of 18 CHCs in the Cape Peninsula providing hypertension and diabetes care was selected. Twenty-five patients with diabetes and 35 with hypertension per clinic were selected and interviewed by trained fieldworkers, and their medical records were audited. Regression analyses identified predictors of controlled hypertension (<140/90 mmHg) and diabetes (HbA1c <7%). In-depth interviews with nurses and doctors explored their experiences in working at the CHCs. Height, weight and blood pressure (BP) were measured for all patients and random blood samples collected for lipids, glucose, HbA1c and creatinine.results. Of the participants 923 had hypertension and 455 diabetes (289 had both conditions). Of the hypertensive patients 33% had a BP <140/90 mmHg, while 42% of the patients with diabetes had non-fasting glucose levels below 11.1 mmol/l. Patients' knowledge about their conditions was poor. Prescriptions for drugs were not recorded in medical records of 22.6% of the patients with diabetes and 11.4% of those with hypertension.conclusions. Primary care for patients with hypertension and diabetes at public sector CHCs is suboptimal. This study highlights the urgent need to improve health care for patients with these conditions in public sector clinics in the Cape Peninsula.

Drug therapy, lifestyle modification and blood pressure control in a primary care facility, south of Johannesburg, South Africa: an audit of hypertension management

“…8,9,[19][20][21] International reports including the United States National Health and Nutrition Examination Survey (2001-2002) 22,23 reported BP control in 53.1% of hypertensive patients, while an Irish survey 24 found BP control in 48.6% of PHC patients. Achieving BP control in 57% of patients in a less resourced PHC setting suggests that PHC has the potential to play a pivotal role in the control of CV diseases in South Africa, since hypertension is the largest contributor to CV diseases.…”

“…4,5 The current South African hypertension guideline 6 is closely aligned to international hypertension guidelines and was developed to ensure, among other things, that BP is optimally controlled, appropriate lifestyle changes are reinforced and antihypertensive drugs are appropriately selected for the management of hypertension. Despite the effectiveness of antihypertensive drugs and lifestyle changes 7 (weight loss, salt restriction, increased physical activity, limited alcohol intake and healthy diet) in lowering BP, these objectives are not being achieved, 8,9 as shown by, e.g. a multi-facility survey in Cape Town, according to which BP control was achieved in only 33% of hypertensive patients.…”

“…a multi-facility survey in Cape Town, according to which BP control was achieved in only 33% of hypertensive patients. 9 Poor adherence to guidelines, inappropriate choice of antihypertensives by clinicians and poor adherence to treatment by patients are partly responsible for this lamentable outcome. 10 A sustained reduction of 5-6 mmHg in diastolic BP has been shown to reduce the incidence of stroke by nearly 40%, coronary events by 15% and heart failure by 50%.…”

Determinants of blood pressure control in rural KwaZulu-Natal, South Africa

“…Similar issues were reported by nurses elsewhere. 4,5 In response to requests for improved education, the principal investigator returned to the Manguzi District eight months after the study to teach the PHC nurses how to facilitate an education session with a group of 10 hypertensive patients. Several nurses commented that the group sessions gave them insight into what patients endured on a daily basis, and found it useful hearing suggestions from patients on how the situation could be improved.…”

“…3 Several studies in South Africa report that only a third of patients who have been prescribed treatment for hypertension have adequately controlled blood pressure (BP < 140/90 mmHg). [4][5][6] Barriers to BP control, as suggested by nurses, include patients not being able to afford transport to the clinics, shortages of medication, inaccurate BP-measuring devices 4 and staff shortages. 6 Poor understanding of hypertension by patients is also likely to contribute.…”