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Use of simulated patients to assess hypertension case management at public healthcare facilities in South Africa

Burger, Ronelle ; Christian, Carmen S ; Gerdtham, Ulf G LU ; Haal, Karel ; Hompashe, Dumisani M ; Smith, Anja and Schutte, Aletta E (2020) In Journal of Hypertension 38(2). p.362-367
Abstract

OBJECTIVE: Our study aims to evaluate hypertensive case management in South Africa's public health sector using simulated patients.

METHOD: Our study describes interactions between hypertensive simulated patients and primary healthcare workers at 39 public sector healthcare facilities in two metropolitan centres in the Eastern and Western Cape Provinces of South Africa. Our analysis focus on 97 interactions where our eight simulated patients tested within range for stage 1 hypertension, that is with SBP 140-159 mmHg and/or DBP 90-99 mmHg. For this subset, we describe how healthcare workers communicated the outcome of the blood pressure test, and whether they follow government guidelines on risk assessment and lifestyle... (More)

OBJECTIVE: Our study aims to evaluate hypertensive case management in South Africa's public health sector using simulated patients.

METHOD: Our study describes interactions between hypertensive simulated patients and primary healthcare workers at 39 public sector healthcare facilities in two metropolitan centres in the Eastern and Western Cape Provinces of South Africa. Our analysis focus on 97 interactions where our eight simulated patients tested within range for stage 1 hypertension, that is with SBP 140-159 mmHg and/or DBP 90-99 mmHg. For this subset, we describe how healthcare workers communicated the outcome of the blood pressure test, and whether they follow government guidelines on risk assessment and lifestyle advice.

RESULTS: Healthcare workers highlighted the risks associated with hypertension in one out of three cases and stressed the importance of regular monitoring of blood pressure in less than half of cases. Hypertensive patients received advice on all six lifestyle risk factors in 8% of cases. 39% of patients received no lifestyle advice at all. In one out of four cases, hypertensive patients left the facility without a hypertension diagnosis and with no prospect of a follow-up visit.

CONCLUSION: Simulated patients can assess the quality of hypertension case management, yielding granular and comprehensive information that can help mobilize resources to improve care. The management of hypertension patients in South African public healthcare facilities is critically insufficient. Given that hypertension is responsible for a rising share of deaths in South Africa and many of these deaths are preventable, urgent intervention is needed.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Hypertension
volume
38
issue
2
pages
6 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85073334166
  • pmid:31584515
ISSN
1473-5598
DOI
10.1097/HJH.0000000000002258
language
English
LU publication?
yes
id
820cd4c8-4565-4d40-ad58-17f961789b0e
date added to LUP
2019-10-16 13:11:36
date last changed
2020-01-16 09:20:27
@article{820cd4c8-4565-4d40-ad58-17f961789b0e,
  abstract     = {<p>OBJECTIVE: Our study aims to evaluate hypertensive case management in South Africa's public health sector using simulated patients.</p><p>METHOD: Our study describes interactions between hypertensive simulated patients and primary healthcare workers at 39 public sector healthcare facilities in two metropolitan centres in the Eastern and Western Cape Provinces of South Africa. Our analysis focus on 97 interactions where our eight simulated patients tested within range for stage 1 hypertension, that is with SBP 140-159 mmHg and/or DBP 90-99 mmHg. For this subset, we describe how healthcare workers communicated the outcome of the blood pressure test, and whether they follow government guidelines on risk assessment and lifestyle advice.</p><p>RESULTS: Healthcare workers highlighted the risks associated with hypertension in one out of three cases and stressed the importance of regular monitoring of blood pressure in less than half of cases. Hypertensive patients received advice on all six lifestyle risk factors in 8% of cases. 39% of patients received no lifestyle advice at all. In one out of four cases, hypertensive patients left the facility without a hypertension diagnosis and with no prospect of a follow-up visit.</p><p>CONCLUSION: Simulated patients can assess the quality of hypertension case management, yielding granular and comprehensive information that can help mobilize resources to improve care. The management of hypertension patients in South African public healthcare facilities is critically insufficient. Given that hypertension is responsible for a rising share of deaths in South Africa and many of these deaths are preventable, urgent intervention is needed.</p>},
  author       = {Burger, Ronelle and Christian, Carmen S and Gerdtham, Ulf G and Haal, Karel and Hompashe, Dumisani M and Smith, Anja and Schutte, Aletta E},
  issn         = {1473-5598},
  language     = {eng},
  number       = {2},
  pages        = {362--367},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Journal of Hypertension},
  title        = {Use of simulated patients to assess hypertension case management at public healthcare facilities in South Africa},
  url          = {http://dx.doi.org/10.1097/HJH.0000000000002258},
  doi          = {10.1097/HJH.0000000000002258},
  volume       = {38},
  year         = {2020},
}