145 lines
4.8 KiB
YAML
145 lines
4.8 KiB
YAML
|
abstract: 'Background: Improved primary health care is needed in developing
|
||
|
|
|
||
|
|
countries to effectively manage the growing burden of hypertension. Our
|
||
|
|
|
||
|
|
objective was to evaluate hypertension management in Zambian rural
|
||
|
|
|
||
|
|
primary care clinics using process and outcome indicators to assess the
|
||
|
|
|
||
|
|
screening, monitoring, treatment and control of high blood pressure.
|
||
|
|
|
||
|
|
Methods: Better Health Outcomes through Mentoring and Assessment (BHOMA)
|
||
|
|
|
||
|
|
is a 5-year, randomized steppedwedge trial of improved clinical service
|
||
|
|
|
||
|
|
delivery underway in 46 rural Zambian clinics. Clinical data were
|
||
|
|
|
||
|
|
collected as part of routine patient care from an electronic medical
|
||
|
|
|
||
|
|
record system, and reviewed for site performance over time according to
|
||
|
|
|
||
|
|
hypertension related indicators: screening (blood pressure measurement),
|
||
|
|
|
||
|
|
management (recorded diagnosis, physical exam or urinalysis), treatment
|
||
|
|
|
||
|
|
(on medication), and control. Quantitative data was used to develop
|
||
|
|
|
||
|
|
guides for qualitative in-depth interviews, conducted with health care
|
||
|
|
|
||
|
|
providers at a proportional sample of half (20) of clinics. Qualitative
|
||
|
|
|
||
|
|
data was iteratively analyzed for thematic content.
|
||
|
|
|
||
|
|
Results: From January 2011 to December 2014, 318,380 visits to 46
|
||
|
|
|
||
|
|
primary care clinics by adults aged >= 25 years with blood pressure
|
||
|
|
|
||
|
|
measurements were included. Blood pressure measurement at vital sign
|
||
|
|
|
||
|
|
screening was initially high at 89. 1\% overall (range: 70.1-100\%), but
|
||
|
|
|
||
|
|
decreased to 62.1\% (range: 0-100\%) by 48 months after intervention
|
||
|
|
|
||
|
|
start. The majority of hypertensive patients made only one visit to the
|
||
|
|
|
||
|
|
clinics (57.8\%). Out of 9022 patients with at least two visits with an
|
||
|
|
|
||
|
|
elevated blood pressure, only 49.3\% had a chart recorded hypertension
|
||
|
|
|
||
|
|
diagnosis. Process indicators for monitoring hypertension were < 10\%
|
||
|
|
|
||
|
|
and did not improve with time. In in-depth interviews, antihypertensive
|
||
|
|
|
||
|
|
medication shortages were common, with 15/20 clinics reporting
|
||
|
|
|
||
|
|
hydrochlorothiazide-amiloride stockouts. Principal challenges in
|
||
|
|
|
||
|
|
hypertension management included 1) equipment and personnel shortages,
|
||
|
|
|
||
|
|
2) provider belief that multiple visits were needed before official
|
||
|
|
|
||
|
|
management, 3) medication stock-outs, leading to improper prescriptions
|
||
|
|
|
||
|
|
and 4) poor patient visit attendance.
|
||
|
|
|
||
|
|
Conclusions: Our findings suggest that numerous barriers stand in the
|
||
|
|
|
||
|
|
way of hypertension diagnosis and management in Zambian primary health
|
||
|
|
|
||
|
|
facilities. Future work should focus on performance indicator
|
||
|
|
|
||
|
|
development and validation in low resource contexts, to facilitate
|
||
|
|
|
||
|
|
regular and systematic data review to improve patient outcomes.'
|
||
|
|
affiliation: 'Yan, LD (Corresponding Author), Ctr Infect Dis Res Zambia, Primary Care
|
||
|
|
\& Hlth Syst Dept, Lusaka, Zambia.
|
||
|
|
|
||
|
|
Yan, LD (Corresponding Author), Stanford Univ, Sch Med, Stanford, CA 94305 USA.
|
||
|
|
|
||
|
|
Yan, Lily D.; Chirwa, Cindy; Chi, Benjamin H.; Bosomprah, Samuel; Sindano, Ntazana;
|
||
|
|
Mwanza, Moses; Musatwe, Dennis; Mulenga, Mary; Chilengi, Roma, Ctr Infect Dis Res
|
||
|
|
Zambia, Primary Care \& Hlth Syst Dept, Lusaka, Zambia.
|
||
|
|
|
||
|
|
Yan, Lily D., Stanford Univ, Sch Med, Stanford, CA 94305 USA.
|
||
|
|
|
||
|
|
Chi, Benjamin H.; Chilengi, Roma, Univ N Carolina, Dept Obstet \& Gynecol, Sch Med,
|
||
|
|
Chapel Hill, NC USA.
|
||
|
|
|
||
|
|
Bosomprah, Samuel, Univ Ghana, Sch Publ Hlth, Dept Biostat, Accra, Ghana.'
|
||
|
|
article-number: '111'
|
||
|
|
author: Yan, Lily D. and Chirwa, Cindy and Chi, Benjamin H. and Bosomprah, Samuel
|
||
|
|
and Sindano, Ntazana and Mwanza, Moses and Musatwe, Dennis and Mulenga, Mary and
|
||
|
|
Chilengi, Roma
|
||
|
|
author-email: lilyyan@alumni.stanford.edu
|
||
|
|
author_list:
|
||
|
|
- family: Yan
|
||
|
|
given: Lily D.
|
||
|
|
- family: Chirwa
|
||
|
|
given: Cindy
|
||
|
|
- family: Chi
|
||
|
|
given: Benjamin H.
|
||
|
|
- family: Bosomprah
|
||
|
|
given: Samuel
|
||
|
|
- family: Sindano
|
||
|
|
given: Ntazana
|
||
|
|
- family: Mwanza
|
||
|
|
given: Moses
|
||
|
|
- family: Musatwe
|
||
|
|
given: Dennis
|
||
|
|
- family: Mulenga
|
||
|
|
given: Mary
|
||
|
|
- family: Chilengi
|
||
|
|
given: Roma
|
||
|
|
da: '2023-09-28'
|
||
|
|
doi: 10.1186/s12913-017-2063-0
|
||
|
|
files: []
|
||
|
|
issn: 1472-6963
|
||
|
|
journal: BMC HEALTH SERVICES RESEARCH
|
||
|
|
keywords: 'Hypertension; Zambia; Mixed methods; Antihypertensive medication;
|
||
|
|
|
||
|
|
Performance indicators; Quality improvement'
|
||
|
|
keywords-plus: 'MIDDLE-INCOME COUNTRIES; PRIMARY-HEALTH-CARE; QUALITY INDICATORS;
|
||
|
|
|
||
|
|
ALMA-ATA; PERFORMANCE; PREVENTION; DISEASE; REBIRTH; AFRICA; NEEDS'
|
||
|
|
language: English
|
||
|
|
month: FEB 3
|
||
|
|
number-of-cited-references: '30'
|
||
|
|
orcid-numbers: 'Yan, Lily/0000-0001-6363-7920
|
||
|
|
|
||
|
|
Bosomprah, PhD, Prof. Samuel/0000-0002-2826-3887'
|
||
|
|
papis_id: 113c0ab858c7fbc675c75a282954ed20
|
||
|
|
ref: Yan2017hypertensionmanageme
|
||
|
|
researcherid-numbers: 'Yan, Lily/AAR-6163-2021
|
||
|
|
|
||
|
|
'
|
||
|
|
times-cited: '14'
|
||
|
|
title: 'Hypertension management in rural primary care facilities in Zambia: a mixed
|
||
|
|
methods study'
|
||
|
|
type: Article
|
||
|
|
unique-id: WOS:000393277500002
|
||
|
|
usage-count-last-180-days: '0'
|
||
|
|
usage-count-since-2013: '11'
|
||
|
|
volume: '17'
|
||
|
|
web-of-science-categories: Health Care Sciences \& Services
|
||
|
|
year: '2017'
|