Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
Medical Teams International, Cox's Bazar, Bangladesh.
BMJ Open Qual. 2022 Dec;11(4). doi: 10.1136/bmjoq-2022-001846.
Non-communicable diseases have overtaken communicable diseases as the most common cause of death worldwide, with the majority of these deaths in low-income and middle-income countries. Hypertension alone causes over nine million deaths per year.Since 2017, around 750 000 Rohingya refugees have fled violence in Myanmar into Cox's Bazar District in Bangladesh. We describe a quality improvement project focused on the management of hypertension in Rohingya refugees in three primary health facilities within the Rohingya refugee camps. The aim of the project was to create a sustainable hypertension service within existing primary care services.A number of plan-do-study-act cycles were performed to improve care, with methods including: creating a specialised clinic, writing a treatment algorithm, training of pharmacists, engaging community health workers and educational programmes for staff and patients.In 2020, 554 patients were engaged in the new hypertension service. Of these, 358 (64.6%) returned for follow-up at least once. Mean systolic blood pressure (BP) was 141.7 (SD 60.0) mm Hg and mean diastolic BP was 88.1 (SD 11.1) mm Hg. Patients engaged in treatment had a significant reduction of BP of 8.2 (95% CI 5.4 to 11.0)/6.0 (95% CI 4.1 to 7.9) mm Hg (p<0.0001).Our project shows that it is possible to create a hypertension service in a challenging humanitarian crisis, which can successfully improve the control of hypertension, although retention in care can be difficult.
非传染性疾病已超过传染性疾病,成为全球范围内导致死亡的最主要原因,其中大多数死亡发生在中低收入国家。仅高血压每年就导致超过 900 万人死亡。自 2017 年以来,约有 75 万罗兴亚难民逃离缅甸的暴力冲突,进入孟加拉国考克斯巴扎尔区。我们描述了一个质量改进项目,该项目专注于罗兴亚难民营内 3 个初级保健设施中罗兴亚难民的高血压管理。该项目的目的是在现有的初级保健服务中创建一个可持续的高血压服务。为了改善护理,我们进行了多次计划-执行-研究-行动循环,方法包括:创建专门的诊所、编写治疗算法、培训药剂师、聘请社区卫生工作者以及为员工和患者提供教育计划。2020 年,有 554 名患者参与了新的高血压服务。其中,358 名(64.6%)至少返回一次进行随访。平均收缩压为 141.7(SD 60.0)mmHg,平均舒张压为 88.1(SD 11.1)mmHg。接受治疗的患者的血压显著降低了 8.2(95%CI 5.4 至 11.0)/6.0(95%CI 4.1 至 7.9)mmHg(p<0.0001)。我们的项目表明,在充满挑战的人道主义危机中创建高血压服务是可行的,它可以成功改善高血压的控制,尽管保持治疗的难度很大。