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Are primary care practitioners in Barbados following hypertension guidelines? - a chart audit
1Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, St, Michael, Barbados. peter.adams@cavehill.uwi.edu.
Insights
Hypertension care in Barbados needs improvement, with inadequate blood pressure control. Key areas for enhancement include body mass assessment, accurate blood pressure measurement, and lifestyle advice, aligning with practice guidelines.
Area of Science:
- Cardiovascular Health
- Public Health
- Primary Care Medicine
Background:
- Hypertension affects 55% of adults aged 40-80 in Barbados.
- The quality of primary care for hypertension relative to established guidelines is not well-understood.
Purpose of the Study:
- To evaluate the quality of hypertension primary care in Barbados.
- To assess adherence to practice guidelines for hypertensive patients.
Main Methods:
- A random sample of charts from hypertensive and diabetic patients was selected from public and private primary care clinics.
- 343 charts of hypertensive patients (≥40 years) were audited for processes of care and blood pressure (BP) control.
- Data collected included patient demographics, diagnosis duration, clinic visits, prescribed medications, and recorded health metrics.
Main Results:
- Only 36% of patients achieved a blood pressure < 140/90 mmHg at their last visit.
- Documentation rates varied significantly for key health indicators, with body mass index (1%) and waist circumference (0%) being notably low.
- Public sector patients showed higher rates for recording weight, cholesterol, albuminuria, creatinine, and dietician/tobacco advice compared to private sector patients.
Conclusions:
- Significant improvements are required in adhering to guidelines for essential interventions like body mass assessment and accurate BP measurement.
- Current hypertension management practices necessitate enhancement in lifestyle advice and medication protocols, including thiazide diuretic use.
- Overall blood pressure control among the hypertensive population in Barbados remains inadequate.
Background:
About 55% of the population 40 to 80 years of age in Barbados is hypertensive. The quality of hypertension primary care compared to available practice guidelines is uncertain.
Findings:
Charts of hypertensive and diabetic patients were randomly sampled at all public and 20 private sector primary care clinics. Charts of all hypertensive patients ≥ 40 years of age were then selected and processes of care and blood pressure (BP) maintenance < 140/90 documented.343 charts of hypertensive patients (170 public, and 173 private) were audited. Patients had the following characteristics: mean age 64 years, female gender 63%, mean duration of diagnosis 9.1 years, and diabetes diagnosed 58%. Patients had an average of 4.7 clinic visits per year, 70% were prescribed a thiazide diuretic, 42% a calcium channel blocker, 40% an angiotensin receptor blocker, and 19% a beta blocker. Public patients compared to private patients were more likely to be female (73% vs. 52%, p < 0.01); have a longer duration of diagnosis (11.7 vs. 6.5 years, p < 0.01), and more clinic visits per year (5.0 vs. 4.5, p < 0.01). Over a 2 year period, the proportion of charts with the following recorded at least once was: BP 98%, weight 80%, total cholesterol 71%, urine tested for albumin 67%, serum creatinine 59%, dietary advice 55%, lipid profile 48%, exercise advice 45%, fasting blood glucose for non-diabetics 39%, dietician referral 21%, tobacco advice 17%, retinal examination 16%, body mass index 1%, and waist circumference 0%. Public patients were more likely to have recorded: weight (92% vs. 68%, p = < 0.01); tests for total cholesterol (77% vs. 67%, p = 0.04), albuminuria (77% vs. 58%, p = < 0.01), serum creatinine (75% vs. 43%, p < 0.01), and fasting blood glucose for non-diabetics (49% vs. 30%, p = 0.02); dietician referral (34% vs. 9%, p < 0.01), and tobacco advice (24% vs. 10%, p < 0.01). Most (92%) diastolic BP readings ended in 0 or 5 (72% ended in 0). At the last visit 36% of patients had a BP < 140/90 mmHg.
Conclusions:
Improvements are needed in following guidelines for basic interventions such as body mass assessment, accurate BP measurement, use of thiazide diuretics and lifestyle advice. BP control is inadequate.
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