Lunt D W, Edwards P R, Steyn K, Lombard C J, Fehrsen G S
Department of Epidemiology and Public Health, Newcastle University, UK.
S Afr Med J. 1998 May;88(5):544-8.
To describe the demographic profile of hypertensive patients and the quality of care for hypertension at a Cape Town community health centre (CHC).
Prospective, descriptive study.
Medium-sized CHC, attended by 1,098 hypertensive patients during a 1-year period from 1 January 1992.
Default rate--proportion of due visits not attended. Loss to follow-up--proportion of patients persistently defaulting or not responding to recall. Frequency of blood pressure measurement--per 12 due visits. Compliance--proportion of patients collecting > or = 75% of antihypertensive drugs. Blood pressure control--mean blood pressure of aggregated readings; and proportion controlled (< 160/95 mmHg) on the basis of all blood pressure readings and mean blood pressures of individual patients with two or more readings during the study period.
More than half (51.6%) of the hypertensive patients were aged > or = 65 years; 81.7% were female. The default rate was between 11.9% and 19.4%. Compliance was high (76.9%). Loss to follow-up was 8.1%. Blood pressure was recorded a mean of 4.0 times per 12 due visits. There were no significant gender differences with regard to these measures. Mean blood pressure was 158.3/89.6 mmHg. Over half (56.7%) of all individual readings over the year were uncontrolled and 51.4% of patients were found to be uncontrolled when categorised by their mean blood pressure. Control was significantly poorer among women > or = 65 years.
We found better compliance, more frequent blood pressure measurement, and lower defaulting and loss to follow-up compared with previous South African studies in similar settings. Despite this, blood pressure control was mediocre. Possible explanations for this are discussed. The low proportion of male hypertensives attending the CHC suggests that the accessibility or acceptability of care is poor for this group. The study illustrates the potential for research in this setting and for the use of computers to monitor the quality of primary care.
描述开普敦一家社区卫生中心（CHC）高血压患者的人口统计学特征以及高血压护理质量。
前瞻性描述性研究。
中型社区卫生中心，在1992年1月1日起的1年时间里有1098名高血压患者就诊。
失访率——未就诊的应就诊次数比例。随访失访——持续失访或对召回无回应的患者比例。血压测量频率——每12次应就诊次数的测量次数。依从性——领取≥75%抗高血压药物的患者比例。血压控制——汇总读数的平均血压；以及根据研究期间所有血压读数和有两次或更多次读数的个体患者的平均血压，血压得到控制（<160/95 mmHg）的比例。
超过一半（51.6%）的高血压患者年龄≥65岁；81.7%为女性。失访率在11.9%至19.4%之间。依从性较高（76.9%）。随访失访率为8.1%。每12次应就诊次数平均记录血压4.0次。在这些指标方面无显著性别差异。平均血压为158.3/89.6 mmHg。一年中超过一半（56.7%）的个体读数未得到控制，按平均血压分类时，51.4%的患者血压未得到控制。65岁及以上女性的血压控制明显较差。
与南非之前在类似环境中的研究相比，我们发现依从性更好、血压测量更频繁、失访和随访失访率更低。尽管如此，血压控制情况一般。对此的可能解释进行了讨论。在社区卫生中心就诊的男性高血压患者比例较低，表明该群体获得医疗服务的可及性或可接受性较差。该研究说明了在这种环境下进行研究以及使用计算机监测初级保健质量的潜力。
