Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Community based Health Research and Development Foundation, Nonthaburi, Thailand.
J Clin Hypertens (Greenwich). 2021 Apr;23(4):702-712. doi: 10.1111/jch.14193. Epub 2021 Jan 27.
A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (<90 beds), large (90-120 beds), and provincial (>120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient's cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p < .01). The hypertension control rate at last visit was 64% but varied between 59% in community hospitals and 71% in large hospitals (p < .01). Failure to adjust medication when required was associated with 30% decrease in the odds of hypertension control (OR 0.69, 95% CI 0. 50 to 0.90). Failure to comply with the treatment guidelines regarding adjustment of medication and lost to follow-up are possible target areas to improve hypertension control in Thailand.
泰国对医院进行了临床审核，以评估其对国家高血压治疗指南的遵守情况，并确定不同规模医疗机构的高血压控制率。采用分层随机抽样的方法，从四个省中选择了十六家不同规模的医院。这些医院包括社区医院（<90 张床位）、大型医院（90-120 张床位）和省级医院（>120 张床位）。在新发病例中，审核确定了以下内容：（i）是否完成了推荐的基线实验室评估，（ii）根据患者的心血管风险，初始药物选择是否合理，（iii）是否在需要时调整了药物。记录了六个月和最后一次就诊时的高血压控制率。在 1406 名患者中，约 75%完成了基线血糖和肾功能评估。近 30%（n=425/1406）的患者需要接受双联治疗，但只有 43%（n=182/425）接受了这种治疗。在治疗过程中，28%（198/1406）需要调整药物，但并未进行调整。治疗开始后六个月的高血压控制率为 53%，社区医院为 51%，大型医院为 56%（p<.01）。最后一次就诊时的高血压控制率为 64%，但社区医院为 59%，大型医院为 71%（p<.01）。需要调整药物而未调整与高血压控制率降低 30%相关（OR 0.69，95%CI 0.50 至 0.90）。未能按照治疗指南调整药物和失访可能是改善泰国高血压控制的目标领域。
