Compliance to standard treatment guidelines in the management of hypertension by health care workers in Potchefstroom sub-district in North west province

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfillment of the requirements for the award of a degree of Master of Medicine in Family MedicineINTRODUCTION Hypertension is one of the leading life style diseases and a main contributor of morbidity and mortality in many countries including South Africa. Standard Treatment Guidelines (STGs) are issued in this country to assist health care workers (HCWs) in the diagnosis and management of common conditions across all levels of care. The STGs include an Essential Drug List (EDL) as supported by WHO Bamako Initiatives (1980) for developing countries. Health systems, patient and physician related factors have been identified as the factors preventing blood pressure (BP) control in patients. OBJECTIVES Considering the debilitating effects caused by hypertension, the objectives were to find out if HCWs diagnose and manage hypertension correctly in terms of compliance to the guidelines. Guidelines are developed from credible evidence based research and are summarized for ease of use by HCWs. Most of the available studies on adherence to guidelines are self-reported and this research seeks to do a record analysis which is different from previous studies. METHOD 21 files of patients diagnosed between April 2009 and March 2011 with 475 documented visits spreading between 2009 and 2014 were purposefully selected from a sample of representative clinics and the hospital in the Potchefstroom sub district. A retrospective cross sectional study was performed using a validated data collection tool. The study included all adults above 18years of age and excluded all patients with co-morbidity at the time of diagnosis. RESULTS The total number of 475 entries represented 21 patients. The majority were males (57%), with a mean age of all patients of 52.81years. The mean systolic BP was 138.48mmHg and diastolic BP was 83.10mmHg. Compliance to diagnosis based on the clinical guideline, was 56% and 75% by nurses and doctors respectively with an overall compliance of 58%. Nurses also did not do well in terms of compliance to drug management at 63.5% with an overall compliance of 62.7%. There was an overall poor compliance to non drug management, where there was no record of health education in 55.8% of patients. CONCLUSIONS This study highlighted the significance of continuous professional development in terms of emphasis on international standards of diagnosis and non drug management. Drug management conforms to international trends of multiple drugs for better management of HPT. However, the generalization and transferability of results is compromised by the limited number of the sample size in the study. Source documents need to be properly monitored and information verified. Peer review of data and management oversight is encouraged. The use of a standard chronic form assisted in the management of patients by simplifying collection and documentation of clinical information over a 12 month period. _______________________________________________________________________________ KEYWORDS: Compliance, guidelines, guideline compliance, hypertension, health care workersMB201