Quality of Care for Hypertension in Primary Health Care in South Africa: Cross-Sectional Feasibility Study

TL;DR

This study assesses the quality of hypertension care in South African primary health clinics and finds significant gaps in treatment and data collection.

Contribution

The study tests 46 quality indicators and recommends 22 to improve hypertension care in primary health settings.

Findings

Only five quality indicators showed a quality of care score for ≥75% of patients.

53.2% of patients had controlled blood pressure, and only 38% received all needed antihypertensive medicines.

Gaps in data collection were identified, such as only 30% of patients having cholesterol or BMI recorded in the last year.

Abstract

Introduction: Little is known about the quality of care for patients with hypertension in primary health care (PHC) facilities in South Africa, where most people receive care. Objectives: To test 46 quality indicators, developed previously, to assess and improve care; to assess the indicators’ clinimetric properties; and to recommend improvement strategies. Methods: A descriptive cross-sectional clinical audit in a purposive sample of 12 South African PHC clinics involving a retrospective review of 295 patient medical records. Results: A total of 45 of the 46 indicators were tested in the main sample (n = 295), of which 9 indicators could not be applied. Of the 36 applicable indicators, 22 could be applied and measured for ≥75% of the sample, while 14 were applicable to ≤50% of the sample. Only five indicators showed a quality of care score for ≥75% of patients. Overall, 82% and 92% of the sample had their blood pressure (BP) recorded in the last 12 months or in the previous 5 years for those aged >40, respectively, and 53.2% had a controlled BP. In the last 12 months, 30% of patients had a cholesterol record, 30% had their BMI recorded, 17% had a hypertension review with a medical practitioner, and 12% had received lifestyle advice. Only 38% received all clinically indicated antihypertensive medicines at their last visit. Conclusion: There were gaps in the quality of care for patients with hypertension, demonstrating the need for greater adherence to evidence-based guidelines, better data quality, and the use of electronic health information systems. Twenty-two indicators are recommended to address these gaps and improve the quality of care, patient outcomes, and the health care system.