Rampamba Enos Muisaphanda, Meyer Johanna Catharina, Godman Brian, Ndwamato Ntodeni Norah, Campbell Stephen Mark
Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Division of Pharmacy Education, Professional Affairs, South African Pharmacy Council, Pretoria, 0001, South Africa.
J Hum Hypertens. 2025 Feb;39(2):155-163. doi: 10.1038/s41371-024-00966-7. Epub 2024 Oct 14.
Despite many quality initiatives at the primary health care (PHC) level, little is known about the actual quality of care of patients diagnosed with hypertension in South Africa. This study aimed to develop quality indicators for hypertension management at the PHC level to improve the quality of care and patient outcomes. The RAND/UCLA Appropriateness Method, comprising two rounds, was used to develop clear, appropriate, and feasible evidence-based quality indicators for hypertension. In Round 1, a 9-point scale was used by a panel of 11 members to rate clarity and appropriateness of 102 hypertension quality indicator statements, grouped under 9 dimensions of quality hypertension management, using an online MS Excel® spreadsheet. In Round 2, 9 of the same panellists discussed all indicators and rated their appropriateness and feasibility during a remote online, interactive face-to-face MS Teams® meeting. Statements rated ≥7-9 with agreement were defined as either appropriate or feasible. The panel rated 46 hypertension quality indicator statements ≥7-9 with agreement for the appropriate and feasible measurement of the management of hypertension: monitoring (n = 16), review (n = 5), lifestyle advice (n = 9), tests (n = 7), intermediate outcomes (n = 6), referrals (n = 2) and practice/facility structures (n = 1). No indicator statements were rated both appropriate and feasible for measuring blood pressure levels and treatment. If applied, these indicators would improve monitoring and management of patients with hypertension, patient outcomes, and data quality in South Africa and result in more efficient use of scarce resources. This study can be replicable for improving care of other non-communicable diseases across Africa.
尽管在初级卫生保健（PHC）层面开展了许多质量改进举措，但对于南非高血压确诊患者的实际医疗质量却知之甚少。本研究旨在制定初级卫生保健层面高血压管理的质量指标，以提高医疗质量和患者治疗效果。采用由两轮组成的兰德/加州大学洛杉矶分校适宜性方法，为高血压制定清晰、恰当且可行的循证质量指标。在第一轮中，11名成员组成的小组使用9分制，通过在线MS Excel®电子表格，对102条高血压质量指标陈述的清晰度和恰当性进行评分，这些陈述分为高血压管理质量的9个维度。在第二轮中，9名相同的小组成员在远程在线交互式面对面MS Teams®会议上讨论了所有指标，并对其恰当性和可行性进行评分。评分≥7 - 9且达成一致的陈述被定义为恰当或可行。该小组对46条高血压质量指标陈述评分≥7 - 9且达成一致，认为这些陈述对高血压管理的测量是恰当且可行的：监测（n = 16）、复查（n = 5）、生活方式建议（n = 9）、检查（n = 7）、中间结果（n = 6）、转诊（n = 2）和实践/机构结构（n = 1）。没有指标陈述在测量血压水平和治疗方面被评为既恰当又可行。如果应用这些指标，将改善南非高血压患者的监测和管理、患者治疗效果以及数据质量，并更有效地利用稀缺资源。本研究可复制用于改善非洲其他非传染性疾病的医疗服务。
