Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
Patient Safety and Risk Management Unit, World Health Organization, Geneva, Switzerland.
PLoS One. 2020 Jan 16;15(1):e0227439. doi: 10.1371/journal.pone.0227439. eCollection 2020.
The global burden of hypertension, currently estimated at 1 billion, is a leading Non-Communicable Disease (NCD) in Sub Saharan Africa. In Tanzania, the reported prevalence of hypertension is 25%. Inherent limitations of the healthcare system to control hypertension include inadequate provider knowledge, system capacity, medication access, and patient awareness, all of which hinder effective screening and disease management. To assess the quality of hypertension screening and patient counseling, we conducted a study in an ambulatory setting in Tanzania.
Observations of patient screening were conducted on 69 adult patients during routine outpatient care and screening camps. In addition, 33 healthcare providers participated in a pre-post knowledge assessment after observing instructional training videos.
Patient observations indicated that blood pressure (BP) measurement was explained to 65% of patients, and 77% of the measurements were made with mercury sphygmomanometers. For several aspects of BP measurement, nurses performed better than doctors: patient's arm supported on a flat surface (doctors, 58% vs nurses 67%, p<0.05), and patient's back was supported (doctors, 50% vs nurses 88%, p<0.01). Among those diagnosed with hypertension, 7% were prescribed medications, 14% were advised on reduced salt during cooking, 29% on reduced salt consumption, 21% on reduced consumption of sodium rich foods, 21% on reducing caloric intake, 21% on increasing physical activity, and 43% were informed about follow up appointments. Provider knowledge assessments showed critical gaps in consequences of hypertension, 1st line medicines, and awareness of guidelines at baseline. Following the instructional videos there were improvements in some aspects: diagnostic criteria for hypertension (pre 45% vs post 91%, p<0.001) and counseling for controlling hypertension (pre 30% vs post 58%, p<0.01).
Enhancing knowledge and performance competencies of health providers at the primary care level is a critical prerequisite for effective hypertension management in low resource settings.
目前全球约有 10 亿人患有高血压，这是撒哈拉以南非洲地区主要的非传染性疾病之一。在坦桑尼亚，高血压的报告患病率为 25%。医疗体系在控制高血压方面存在固有局限性，包括医务人员知识不足、系统能力有限、药物获取途径受限以及患者意识薄弱，所有这些都阻碍了有效的筛查和疾病管理。为了评估高血压筛查和患者咨询的质量，我们在坦桑尼亚的一个门诊环境中进行了一项研究。
在常规门诊护理和筛查营地期间，对 69 名成年患者进行了患者筛查观察。此外，在观看教学培训视频后，33 名医疗保健提供者参加了一项前后知识评估。
患者观察结果表明，血压（BP）测量向 65%的患者进行了解释，并且 77%的测量使用了水银血压计进行。在血压测量的几个方面，护士的表现优于医生：患者手臂放在平坦表面上（医生，58%比护士，67%，p<0.05），并且患者背部得到支撑（医生，50%比护士，88%，p<0.01）。在被诊断患有高血压的患者中，有 7%被开了药物，14%被建议在烹饪时减少盐的摄入，29%被建议减少盐的消耗，21%被建议减少富含钠的食物的消耗，21%被建议减少热量摄入，21%被建议增加体育锻炼，43%被告知要进行随访预约。提供者知识评估显示，在高血压的后果、一线药物和对指南的认识方面存在严重差距。观看教学视频后，某些方面有所改善：高血压的诊断标准（之前 45%比之后 91%，p<0.001）和控制高血压的咨询（之前 30%比之后 58%，p<0.01）。
在初级保健层面增强卫生保健提供者的知识和技能水平，是在资源匮乏环境中有效管理高血压的关键前提。
