An assessment of quality of care in hypertension

Abstract

Aims: Hypertension is widely prevalent, and is a major cause of cardiovascular sequelae; it is well known that many patients fail to meet accepted targets. Access, adherence and the quality of the care process have all been implicated in improving control. Hypertension is a frequent cause for referral to Schedule V Clinics to access free treatment. Optimal management requires adequate assessment, and management of existing co-morbidities including coronary artery disease, diabetes mellitus and hyperlipidaemia. The aim of this study was to assess the quality of care hypertensive patients receive through this channel during routine care. Methods: One hundred sequential patients attending Floriana and Gzira Health Centres for free medication under the Schedule V Act were assessed prospectively in April 2007. Evidence-based quality indicators were identified from the literature. These include confirmation of the diagnosis, identification of co-morbidities, (including coronary artery disease, diabetes and hyperlipidaemia), blood pressure readings, laboratory results including serum creatinine, lipid profile, sodium, potassium and urinalysis, prescriptions for antihypertensive agents, and counselling for lifestyle modification. Results: 51% of hypertensives were controlled at presentation; Older age was associated with better blood pressure control. 2% were found to have white coat hypertension; 28% had not been investigated prior to referral; (or were inadequately investigated). 17% had coronary artery disease; 61% hyperlipidaemia; 58% hyperglycaemia; many were unaware of pre-existing co-morbidities. All patients received lifestyle modification information. Conclusions: A surprisingly large cohort of patients were found to have undiagnosed co-morbidities, with diabetes and hyperlipidaemia being the most prevalent. Schedule V clinics are a good focal point to identify modifiable risk factors for preventive care.