Lacey Stephanie, Odland Maria Lisa, Sié Ali, Harling Guy, Bärnighausen Till, Geldsetzer Pascal, Hirschhorn Lisa R, Davies Justine I
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
PLOS Glob Public Health. 2025 Apr 2;5(4):e0003161. doi: 10.1371/journal.pgph.0003161. eCollection 2025.
Providing quality healthcare is essential to reduce the future burden of cardiovascular disease. We assessed the quality of care for people with hypertension in Burkina Faso using the Institute of Medicine (IoM) Quality Domains of effectiveness, timeliness of access, patient-centredness and equitability of care. We performed an analysis of cross-sectional household survey data collected from a population-representative sample of 4000 adults ≥40 years in Nouna, Burkina Faso in 2018. For people with hypertension, effectiveness was assessed through care cascades describing the proportion who were screened, diagnosed, treated, and achieved hypertension control; timeliness was defined as access to care within the last three months. Patient-centredness was described using experiential quality process and outcome measures (dichotomised as higher or lower quality [score above or below and including the median, respectively]; a shared understanding and decision-making (SUDM) variable was described. Equity was assessed for effectiveness, timeliness, and patient-centredness in multivariable analyses including socio-demographic factors. In total, 1006 participants with hypertension were included. Hypertension prevalence was 34.8%; 62.3% had been screened, 42.9% diagnosed, 15.0% treated, and 6.8% were controlled; 26.8% had accessed care within the last three months. Overall, 61.8% of participants had a positive view of the health service. Clarity of communication and opinion of medical provider knowledge were the best-rated experiential quality process variables, with 40.1% and 39.7% of participants´ responses indicating higher quality care respectively. The mean SUDM score was 68.5 (±10.8), range 25.0-100.0. Regarding equity, screening was higher in females, adults with any education, those who were married or cohabiting, and those in the higher wealth quintiles. There were no associations seen between SUDM and sociodemographic variables. Although the prevalence of hypertension was high in this population, the quality of care was not commensurate, with room for improvement in all four IoM Domains assessed.
提供高质量的医疗保健对于减轻未来心血管疾病的负担至关重要。我们使用医学研究所（IoM）的有效性、就医及时性、以患者为中心以及医疗公平性等质量领域，评估了布基纳法索高血压患者的医疗质量。我们对2018年从布基纳法索努纳4000名40岁及以上成年人的具有人群代表性样本中收集的横断面家庭调查数据进行了分析。对于高血压患者，有效性通过描述筛查、诊断、治疗以及实现高血压控制比例的治疗流程进行评估；及时性定义为在过去三个月内获得医疗服务。以患者为中心通过体验质量过程和结果指标来描述（分为高质量或低质量[分数分别高于或低于及包括中位数]）；描述了一个共同理解和决策（SUDM）变量。在包括社会人口因素的多变量分析中评估了有效性、及时性和以患者为中心方面的公平性。总共纳入了1006名高血压参与者。高血压患病率为34.8%；62.3%接受了筛查，42.9%被诊断，15.0%接受了治疗，6.8%得到了控制；26.8%在过去三个月内获得了医疗服务。总体而言，61.8%的参与者对医疗服务持积极看法。沟通清晰度和对医疗服务提供者知识的评价是体验质量过程变量中评价最高的，分别有40.1%和39.7%的参与者的回答表明医疗质量较高。SUDM平均得分为68.5（±10.8），范围为25.0 - 100.0。在公平性方面，女性、受过任何教育的成年人、已婚或同居者以及财富五分位数较高的人群筛查率较高。SUDM与社会人口变量之间未发现关联。尽管该人群中高血压患病率较高，但医疗质量并不相称，在所评估的所有四个IoM领域都有改进空间。
