How to improve the quality of care for patients with hypertension at Moshupa clinics, Moshupa District, Botswana : quality improvement cycle

Kande, C. N. (2013-03)

Thesis (MFamMed)--Stellenbosch University, 2015.


ENGLISH ABSTRACT: INTRODUCTION Although there are no prevalence studies in Botswana, hypertension is thought to be very common. It is commonly asymptomatic, readily detectable by blood pressure measurement and can lead to complications if untreated. Treatment can reduce these complications and yet the quality of care is thought to be poor. The aim of this project was to assess and improve the quality of care for hypertension at Moshupa clinics in Botswana. METHODS This project was a quality improvement cycle comprising the following steps: establishment of the quality improvement team, setting up of target standards, data collection and analysis, comparison of results to target standards, reflection and planning of change to clinical practice, implementation of the changes, and re-audit after 6-months to detect any improvement in the quality of care. Target standards were set for structure, process and outcome. RESULTS 200 participants were included in the audit, 68% women with a mean age of 55 years. In the baseline audit none of the targets standards were met. During the re audit the structural criteria were the most improved with six targets out of nine achieved. The process criteria showed five targets were achieved out of 11 and the outcome criteria met one target out of two. Significant improvement in performance was shown in ten criteria although the target standard was not always met. In the re-audit the target of achieving control (<140/90) in 70% of patients was achieved. CONCLUSION The quality of care of hypertension was suboptimal in our setting as highlighted by the baseline audit. Simple interventions were designed and implemented to improve the quality of care of hypertensive patients. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen. It is recommended that the quality improvement process be continued, expanded to other clinics and to other chronic conditions.

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