2023-09-28 14:46:10 +00:00
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abstract: 'Background: Improved primary health care is needed in developing
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countries to effectively manage the growing burden of hypertension. Our
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objective was to evaluate hypertension management in Zambian rural
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primary care clinics using process and outcome indicators to assess the
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screening, monitoring, treatment and control of high blood pressure.
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Methods: Better Health Outcomes through Mentoring and Assessment (BHOMA)
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is a 5-year, randomized steppedwedge trial of improved clinical service
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delivery underway in 46 rural Zambian clinics. Clinical data were
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collected as part of routine patient care from an electronic medical
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record system, and reviewed for site performance over time according to
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hypertension related indicators: screening (blood pressure measurement),
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management (recorded diagnosis, physical exam or urinalysis), treatment
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(on medication), and control. Quantitative data was used to develop
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guides for qualitative in-depth interviews, conducted with health care
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providers at a proportional sample of half (20) of clinics. Qualitative
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data was iteratively analyzed for thematic content.
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Results: From January 2011 to December 2014, 318,380 visits to 46
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primary care clinics by adults aged >= 25 years with blood pressure
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measurements were included. Blood pressure measurement at vital sign
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screening was initially high at 89. 1\% overall (range: 70.1-100\%), but
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decreased to 62.1\% (range: 0-100\%) by 48 months after intervention
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start. The majority of hypertensive patients made only one visit to the
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clinics (57.8\%). Out of 9022 patients with at least two visits with an
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elevated blood pressure, only 49.3\% had a chart recorded hypertension
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diagnosis. Process indicators for monitoring hypertension were < 10\%
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and did not improve with time. In in-depth interviews, antihypertensive
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medication shortages were common, with 15/20 clinics reporting
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hydrochlorothiazide-amiloride stockouts. Principal challenges in
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hypertension management included 1) equipment and personnel shortages,
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2) provider belief that multiple visits were needed before official
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management, 3) medication stock-outs, leading to improper prescriptions
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and 4) poor patient visit attendance.
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Conclusions: Our findings suggest that numerous barriers stand in the
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way of hypertension diagnosis and management in Zambian primary health
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facilities. Future work should focus on performance indicator
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development and validation in low resource contexts, to facilitate
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regular and systematic data review to improve patient outcomes.'
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affiliation: 'Yan, LD (Corresponding Author), Ctr Infect Dis Res Zambia, Primary Care
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\& Hlth Syst Dept, Lusaka, Zambia.
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Yan, LD (Corresponding Author), Stanford Univ, Sch Med, Stanford, CA 94305 USA.
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Yan, Lily D.; Chirwa, Cindy; Chi, Benjamin H.; Bosomprah, Samuel; Sindano, Ntazana;
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Mwanza, Moses; Musatwe, Dennis; Mulenga, Mary; Chilengi, Roma, Ctr Infect Dis Res
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Zambia, Primary Care \& Hlth Syst Dept, Lusaka, Zambia.
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Yan, Lily D., Stanford Univ, Sch Med, Stanford, CA 94305 USA.
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Chi, Benjamin H.; Chilengi, Roma, Univ N Carolina, Dept Obstet \& Gynecol, Sch Med,
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Chapel Hill, NC USA.
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Bosomprah, Samuel, Univ Ghana, Sch Publ Hlth, Dept Biostat, Accra, Ghana.'
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article-number: '111'
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author: Yan, Lily D. and Chirwa, Cindy and Chi, Benjamin H. and Bosomprah, Samuel
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and Sindano, Ntazana and Mwanza, Moses and Musatwe, Dennis and Mulenga, Mary and
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Chilengi, Roma
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author-email: lilyyan@alumni.stanford.edu
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author_list:
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- family: Yan
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given: Lily D.
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- family: Chirwa
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given: Cindy
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- family: Chi
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given: Benjamin H.
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- family: Bosomprah
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given: Samuel
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- family: Sindano
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given: Ntazana
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- family: Mwanza
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given: Moses
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- family: Musatwe
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given: Dennis
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- family: Mulenga
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given: Mary
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- family: Chilengi
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given: Roma
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da: '2023-09-28'
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doi: 10.1186/s12913-017-2063-0
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files: []
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issn: 1472-6963
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journal: BMC HEALTH SERVICES RESEARCH
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keywords: 'Hypertension; Zambia; Mixed methods; Antihypertensive medication;
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Performance indicators; Quality improvement'
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keywords-plus: 'MIDDLE-INCOME COUNTRIES; PRIMARY-HEALTH-CARE; QUALITY INDICATORS;
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ALMA-ATA; PERFORMANCE; PREVENTION; DISEASE; REBIRTH; AFRICA; NEEDS'
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language: English
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month: FEB 3
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number-of-cited-references: '30'
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orcid-numbers: 'Yan, Lily/0000-0001-6363-7920
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Bosomprah, PhD, Prof. Samuel/0000-0002-2826-3887'
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papis_id: 113c0ab858c7fbc675c75a282954ed20
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ref: Yan2017hypertensionmanageme
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researcherid-numbers: 'Yan, Lily/AAR-6163-2021
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'
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times-cited: '14'
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title: 'Hypertension management in rural primary care facilities in Zambia: a mixed
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methods study'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000393277500002
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usage-count-last-180-days: '0'
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usage-count-since-2013: '11'
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volume: '17'
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web-of-science-categories: Health Care Sciences \& Services
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year: '2017'
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