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A structured record to implement the national guidelines for diabetes and hypertension care
A R Daniels1, M Patel, R Biesma
1Programme for Chronic Diseases of Lifestyle, Medical Research Council, Tygerberg, W Cape.
Background:
Guidelines to improve standards of care for hypertension and diabetes were disseminated by the National Department of Health in 1996 but have generally not been implemented by health professional in local primary care. A strategy for the adoption and implementation of the Guidelines was developed in collaboration with health professionals in primary care.
Objectives:
The development of a structured record, with prompts for the management of diabetes and hypertension according to the Guidelines.
Setting:
Three community health centres (CHCs) in the Western Cape.
Participants:
Doctors and nurses managing patients with diabetes and hypertension.
Methods:
A draft of the structured record was developed at a single-pilot CHC in the Western Cape. Focus group discussions established the core requirements for a structured record. Process, result and structural indicators in line with the national Guidelines were considered for inclusion in the draft record. This draft record was then piloted at two other CHCs. Comments from semi-structured interviews and pre- and post-test evaluation questionnaires were used to compile the final instrument.
Results:
Eleven doctors and 8 nurses participated in the development of the final instrument. Important considerations in the design were a single-page, user-friendly format, tick-boxes to reduce writing, prompts, provision for sequential recording, target setting, and compatibility with the Guidelines. The final instrument was piloted and elicited a favourable overall response.
Conclusion:
The structured record simplifies the application of the Guidelines and the systematic recording of processes of care. The effectiveness of the Guidelines will be evaluated further in a randomised control trial using the structured record.