Hypertension care at a Cape Town community health centre
Abstract
Objectives. To describe the demographic profile of hypertensive patients and the quality of care for hypertension at a Cape Town community health centre (CHC).
Design. Prospective, descriptive study.
Setting and subjects. Medium-sized CHC, attended by 1098 hypertensive patients during a 1-year period from 1 January 1992.
Outcome measures. Default rate - proportion of due visits not attended. Loss to follow-up - proportion of patients persistently defaulting or not responding to recall. Frequency of blood pressure measurement - per 12 due visits. Compliance - proportion of patients collecting ≥ 75% of antihypertensive drugs. Blood pressure control - mean blood pressure of aggregated readings; and proportion controlled (<160/95 mmHg) on the basis of all blood pressure readings and mean blood pressures of individual patients with two or more readings during the study period.
Results. More than half (51.6%) of the hypertensive patients were aged ≥ 65 years; 81.7% were female. The default rate was between 11.9% and 19.4%. Compliance was high (76.9%). Loss to follow-up was 8.1 %. Blood pressure was recorded a mean of 4.0 times per 12 due visits. There were no significant gender differences with regard to these measures. Mean blood pressure was 158.3/89.6 mmHg. Over half (56.7%) of all individual readings over the year were uncontrolled and 51.4% of patients were found to be uncontrolled when categorised by their mean blood pressure. Control was significantly poorer among women ≥ 65 years.
Conclusion. We found better compliance, more frequent blood pressure measurement, and lower defaulting and loss to follow-up compared with previous South African studies in similar settings. Despite this, blood pressure control was mediocre. Possible explanations for this are discussed. The low proportion of male hypertensives attending the CHC suggests that the accessibility or acceptability of care is poor for this group. The study illustrates the potential for research in this setting and for the use of computers to monitor the quality of primary care.
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