# 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.

## Key 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.