Acceptability of Hypertension Quality Indicators in Primary Care in South Africa: Exploratory Implementation Research

Background/Objectives: Hypertension contributes to almost 5 million deaths annually, exacerbated by poor quality of care. Currently in South Africa, the quality of care for patients with hypertension is unknown, and there have been no agreed-upon quality indicators to measure this at the primary healthcare (PHC) level. Quality indicators have previously been developed to address this although their acceptability in PHC facilities in South Africa has not been established. Consequently, we aimed to explore the acceptability of these indicators, and their subsequent use for monitoring adherence to hypertension guidelines, as well as assess their availability and accessibility. Subsequently, identify recommendations for service-delivery changes to improve the uptake of evidence-based indicators into routine practice and the quality of hypertension care in South Africa. Methods: Questionnaire survey during semi-structured interviews with one key informant from 12 PHC clinics where the indicators had previously been tested. Results: Most facilities accepted hypertension quality indicators to improve hypertension management and patient outcomes. Ten clinics had assessed the facility's quality of care, and all had access to hypertension guidelines. However, only two clinics had a hypertension-specific patient register. Concerns also included a manual data management system and nurse shortages. Conclusions: Large-scale application of quality indicators would facilitate evidence-based decisions for future use at PHC clinics to improve monitoring of adherence to hypertension guidelines and patient outcomes. However, this needs investing in electronic information management to improve data accuracy and management alongside a nursing workforce strategy. Replicating this study in other LMICs can provide comparable preliminary data within the region.