Hypertension management in rural primary care facilities in Zambia: a mixed methods study

• Published in: BMC health services research 2017-02, Vol.17 (1), p.111-111, Article 111
• Main Authors: Yan, Lily D, Chirwa, Cindy, Chi, Benjamin H, Bosomprah, Samuel, Sindano, Ntazana, Mwanza, Moses, Musatwe, Dennis, Mulenga, Mary, Chilengi, Roma
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Antihypertensive agents; Antihypertensive Agents - therapeutic use; Blood pressure; Business metrics; Care and treatment; Charitable foundations; Clinics; Consent; Data collection; Developing Countries; Diagnosis; Dosage and administration; Electronic health records; Female; Health aspects; Health facilities; Health screening; Humans; Hypertension; Hypertension - drug therapy; Interviews; Interviews as Topic; Male; Medical records; Mortality; Outcome Assessment, Health Care; Patients; Primary care; Primary health care; Primary Health Care - standards; Qualitative Research; Quality; Quality Improvement; Quality of Health Care; Quantitative analysis; Randomized Controlled Trials as Topic; Rural Health Services; Zambia
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-017-2063-0

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. Better Health Outcomes through Mentoring and Assessment (BHOMA) is a 5-year, randomized stepped-wedge 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. 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