Compliance with the guidelines for the management of cardiovascular risk factors in patients with hypertension and/or diabetes mellitus.

Abstract

Background: Globally, the burden of cardiovascular diseases (CVDs) is increasing. In South Africa (SA), evidence-based management guidelines and clinical tools containing symptom-based algorithms and checklists have been implemented as interventions for use by clinicians at the primary health care (PHC) level. Clinicians are expected to fully comply with these guidelines to improve the quality of care and clinical outcomes. Objective: To determine clinician compliance with Primary Care (PC) 101 guidelines for the management of cardiovascular risk factors in patients with hypertension (HTN) and diabetes mellitus (DM). Method: In this retrospective study, we reviewed medical records of patients aged 18 years and older who were receiving chronic care for HTN, DM, or both, at a PHC clinic, in KwaZulu Natal, SA, between June 2015 and August 2016, excluding newly diagnosed patients. Results: Of the 99 patients included, 82 (83%) were females, and 88 (89%) were black; 70 (71%) patients had HTN, 27 (27%) had both HTN and DM, and 2 (2%) had DM only. The mean (SD) age was 60 (12) years. Of those with HTN (n = 70), blood pressure (BP) was measured in 57 (81%) at baseline, 56 (80%) at 6 months, and 62 (87%) at 12 months; body mass index (BMI) was documented in 10 (14%) and an estimated glomerular filtration rate (eGFR) done in 59 (84%). In those diagnosed with both HTN and DM (n = 27), BP was measured in 25 (93%) at baseline, 26 (96%) at 6 months, and 24 (89%) at 12 months; glucometer reading (GR) was checked in 22 (82%) at baseline and 6 months, and 20 (74%) at 12 months; feet examination and urine dipsticks analysis were documented in 1 (4%), and eye examination and BMI in 2 (7%); eGFR was performed in 21 (78%) and hemoglobin A1c (HbA1c) in 16 (59%). Of the patients with DM only (n =2), BMI, eye and feet examination were recorded in 0% and urine dipsticks analysis done in 1 (50%). Conclusion: This study showed low rate of clinician compliance with PC101 guidelines at a PHC clinic. However, reasons for clinicians’ non-compliance were not explored. This emphasizes the need for future investigations to identify barriers to following guidelines.