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Hypertension control in Harare municipal clinics
T Bassett1, E Z Ndoro, A Mhadzemira
1Department of Community Medicine, Avondale, Harare.
Insights
A nurse-led hypertension program in Zimbabwe successfully managed stable patients, but improved compliance and treatment are needed for greater public health impact. The study highlights challenges in patient follow-up and adherence.
Area of Science:
- Public Health
- Cardiovascular Medicine
- Health Services Management
Background:
- Hypertension management presents a significant challenge to urban health services in Zimbabwe.
- The Harare Health Department established a dedicated registry for stable hypertension patients in 1980.
- This program aimed to manage patients with diastolic blood pressure (DBP) below 100 mmHg on treatment.
Purpose of the Study:
- To evaluate the effectiveness of a nurse-managed hypertension control program.
- To assess patient outcomes and identify areas for improvement in hypertension care in Zimbabwe.
Main Methods:
- Retrospective review of 437 medical records of patients in the hypertension registry.
- Analysis of patient demographics, blood pressure control, treatment strategies, and follow-up compliance.
- Statistical analysis to identify factors associated with treatment outcomes (p < 0.05).
Main Results:
- The average patient age was 17.5 years, with two-thirds being women.
- 74% of patients had DBP < 100 mmHg upon referral, and 65% maintained DBP < 100 mmHg during follow-up.
- One-third of patients enrolled between 1980-1986 were lost to follow-up; regular attendance was low among those who did not default.
Conclusions:
- A nurse can effectively manage stable hypertension patients, demonstrating the potential for task-shifting in healthcare.
- Improved treatment intensity and enhanced patient compliance are crucial for better hypertension control.
- High loss to follow-up rates currently limit the program's public health impact, emphasizing the need to address patient adherence.
Abstract:
Treatment of hypertension is a growing burden on urban health services in Zimbabwe. In 1980, the Harare Health Department began a separate registry, staffed by a nurse, for management of patients with stable hypertension (diastolic blood pressure (DBP less than 100 mmHg) on treatment). We evaluated this programme in a retrospective review of 437 medical records. The average age of patients was 17.5 years; two-thirds were women. Upon referral 324 patients (74 percent) had a DBP less than mmHg. Sixty-five percent of patients had no DBP greater than 100 mmHg during follow-up. Patients with DBP greater than 20 mmHg were more likely to be treated with two drugs, seen more often or referred (p less than 05). One-third of patients enrolled between 1980-1986 were lost to follow-up. Of those who did not default, few attended regularly. We conclude that a nurse can successfully manage patients with stable hypertension, although more aggressive treatment and improved compliance would have resulted in better control. At current levels of loss to follow-up, this programme is unlikely to have much effect on the public health impact of hypertension. The main challenge is to improve patient compliance.