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Hypertension care at a Cape Town community health centre
D W Lunt1, P R Edwards, K Steyn
1Department of Epidemiology and Public Health, Newcastle University, UK.
Insights
Hypertension care in Cape Town showed good patient compliance and lower follow-up loss, but blood pressure control remains mediocre, especially in elderly women. This highlights potential issues with healthcare accessibility for men.
Area of Science:
- Public Health
- Cardiology
- Primary Care Research
Background:
- Hypertension management in community health centers (CHCs) is crucial for public health.
- Understanding patient demographics and care quality is essential for improving hypertension outcomes.
Purpose of the Study:
- To characterize the demographic profile of hypertensive patients at a Cape Town CHC.
- To evaluate the quality of hypertension care, including blood pressure control and patient adherence.
Main Methods:
- A prospective, descriptive study was conducted over one year at a medium-sized CHC.
- Data collected included patient demographics, default rates, loss to follow-up, medication compliance, and blood pressure control metrics for 1,098 hypertensive patients.
Main Results:
- The patient population was predominantly elderly (51.6% >65 years) and female (81.7%).
- Compliance was high (76.9%), with lower-than-expected default (11.9-19.4%) and loss to follow-up (8.1%) rates.
- Despite improvements in care metrics, blood pressure control was mediocre, with over half of readings and patients uncontrolled (<160/95 mmHg). Control was poorer in elderly women.
Conclusions:
- While compliance and follow-up metrics improved compared to previous studies, blood pressure control remains a significant challenge.
- The low attendance of male hypertensive patients suggests potential barriers to care accessibility or acceptability.
- The study underscores the need for enhanced strategies to improve hypertension control in primary care settings and highlights the utility of computer-assisted monitoring.
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 1,098 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 > or = 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 > or = 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 > or = 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.