Steyn Krisela, Levitt Naomi S, Patel Maya, Fourie Jean, Gwebushe Nomonde, Lombard Carl, Everett Kathy
Department of Medicine, University of Cape Town.
S Afr Med J. 2008 Aug;98(8):618-22.
To identify health care provider-related determinants of diabetes and hypertension management in patients attending public sector community health centres (CHCs).
A random sample of 18 CHCs in the Cape Peninsula providing hypertension and diabetes care was selected. Twenty-five patients with diabetes and 35 with hypertension per clinic were selected and interviewed by trained fieldworkers, and their medical records were audited. Regression analyses identified predictors of controlled hypertension (< 140/90 mmHg) and diabetes (HbA1c < 7%). In-depth interviews with nurses and doctors explored their experiences in working at the CHCs. Height, weight and blood pressure (BP) were measured for all patients and random blood samples collected for lipids, glucose, HbA1c and creatinine.
Of the participants 923 had hypertension and 455 diabetes (289 had both conditions). Of the hypertensive patients 33% had a BP < 140/90 mmHg, while 42% of the patients with diabetes had non-fasting glucose levels below 11.1 mmol/l. Patients' knowledge about their conditions was poor. Prescriptions for drugs were not recorded in medical records of 22.6% of the patients with diabetes and 11.4% of those with hypertension.
Primary care for patients with hypertension and diabetes at public sector CHCs is suboptimal. This study highlights the urgent need to improve health care for patients with these conditions in public sector clinics in the Cape Peninsula.
确定在公立部门社区卫生中心（CHC）就诊的患者中，与医疗服务提供者相关的糖尿病和高血压管理的决定因素。
从开普半岛提供高血压和糖尿病护理的18个CHC中随机抽取样本。每个诊所选取25名糖尿病患者和35名高血压患者，由经过培训的现场工作人员进行访谈，并对他们的病历进行审核。回归分析确定了高血压得到控制（<140/90 mmHg）和糖尿病（糖化血红蛋白<7%）的预测因素。对护士和医生进行深入访谈，探讨他们在CHC工作的经历。测量所有患者的身高、体重和血压（BP），并采集随机血样检测血脂、血糖、糖化血红蛋白和肌酐。
参与者中，923人患有高血压，455人患有糖尿病（289人同时患有这两种疾病）。高血压患者中，33%的血压<140/90 mmHg，而糖尿病患者中，42%的非空腹血糖水平低于11.1 mmol/l。患者对自身病情的了解较差。22.6%的糖尿病患者和11.4%的高血压患者的病历中未记录药物处方。
公立部门CHC对高血压和糖尿病患者的初级护理并不理想。本研究强调了迫切需要改善开普半岛公立部门诊所中这些患者的医疗服务。
