wow-inequalities/02-data/intermediate/wos_sample/73be20da749d2139cf7f2f727bb5c052-yan-lily-d.-and-chi/info.yaml

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2023-09-28 14:46:10 +00:00
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'
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
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'