Lulebo Aimée M, Kaba Didine K, Atake Silvestre E-H, Mapatano Mala A, Mafuta Eric M, Mampunza Julien M, Coppieters Yves
Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Faculty of Economics and Management (FASEG), University of Lomé, Lomé, Togo.
BMC Health Serv Res. 2017 Dec 4;17(Suppl 2):698. doi: 10.1186/s12913-017-2645-x.
The Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC.
We conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses.
Almost half the patients were female (53.1%), patients' mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8-28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3-16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively).
Uncontrolled HTN was not associated with the type of health facility. This finding suggests that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.
刚果民主共和国（DRC）的特点是高血压（HTN）患病率高且未控制的高血压比例高，这表明高血压管理不善。由于资源有限，特别是卫生人力资源有限，非洲地区有效管理高血压具有挑战性。为解决卫生工作者短缺问题，世界卫生组织（WHO）建议进行任务转移以改善疾病管理和治疗。尽管刚果民主共和国正在实施从医生到护士的任务转移，但据我们所知，尚无研究记录任务转移与高血压控制之间的关联。本研究的目的是调查刚果民主共和国金沙萨任务转移与高血压控制之间的关联。
我们于2015年12月至2016年1月在金沙萨的五家综合转诊医院（GRH）和九个卫生中心（HC）进行了一项横断面研究。共有260名高血压患者参与了该研究。使用结构化问卷收集社会人口统计学、临床、医疗保健成本和感知医疗保健质量评估数据。为了研究任务转移与高血压控制之间的关联，我们使用双变量和多变量分析评估了GRH患者和HC患者之间的差异。
几乎一半的患者为女性（53.1%），患者的平均年龄为59.5±11.4岁。超过四分之三的患者患有未控制的高血压。GRH患者和HC患者中未控制高血压的比例没有显著差异（76.2%对77.7%，p = 0.771）。未控制的高血压与合并症（OR = 10.3；95% CI：3.8 - 28.3）和所用抗高血压药物的类型（OR = 4.6；95% CI：1.3 - 16.1）相关。GRH的平均医疗保健成本显著高于HC的成本（分别为34.2美元±3.34美元和7.7美元±0.6美元）。
未控制的高血压与医疗机构类型无关。这一发现表明，初级卫生保健层面的高血压管理可能与二级层面同样有效。然而，未控制高血压患者的高比例凸显了在所有医疗保健层面制定高血压管理指南的必要性。
