Evaluation of the effect of the introduction of a hypertension club on the management of hypertension at a community health centre in the Cape Town Metropole
Background: Hypertension is a widespread problem of immense economic importance in sub-Saharan Africa because of its high prevalence in urban areas, its frequent under-diagnosis, and the severity of its complications. A systematic review of interventions used to improve the management of hypertension in primary care showed that effective delivery of hypertensive care requires a systematic approach in the community. The rationale for establishing a hypertension club at the Mitchell's Plain Community Health Centre (MPCHC), Cape Town, South Africa is based on the findings of and recommendations made by a study done previously at MPCHC by the Chronic Diseases of Lifestyle Programme of the Medical Research Council. This study found that the blood pressure of hypertensive patients was not optimally controlled and both the drug and non-drug management of hypertension needed to be improved. The patients had asked for the introduction of a dedicated hypertension club. Methods: A dedicated hypertension club was started at MPCHC and hypertensive patients were enrolled. A booking system with an appointment register was initiated. A hypertension record sheet was kept in the patient's folder. Observations like blood pressure (BP), weight, and urinalysis were recorded by the club's nurses. Health information officers were used to educate the patients about hypertension, its treatment and complications. The doctors' role was to fully assess the patients' risk profiles and to develop a management plan. To audit the club, a questionnaire was conducted on an initial group of 100 patients at the inception of the club and repeated on a group of 100 patients after six months. The aim was to assess the patients' knowledge of issues affecting the management of hypertension and their satisfaction with the service received at MPCHC. A folder review was done on the second group of patients. The intention was to evaluate whether there had been a change in the patients' BP over the preceding six months, whether the patients were compliant and whether observations were made regularly. Results: The average age of the study population was early sixties. More women than men were studied. The knowledge of the follow-up group regarding factors affecting hypertension control was slightly better than that of the initial group, but remained poor. The knowledge of the consequences of poor hypertension control did not improve after six months. Salt use stayed the same. The patients were satisfied with the service received, although shorter waiting times were desired. About 64% of the patients had collected their medication as per schedule. In the initial group, 48% of the patients had a BP > 140/90 mmHg. After six months, 33% of the patients had a BP > 140/90 mmHg. Conclusions: The study did not show much change in the patients' knowledge in the first six months after the institution of the hypertension club. Compliance was poor, although BP control improved somewhat. The benefit was in setting up the system.