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Health practitioners' state of knowledge and challenges to effective management of hypertension at primary level.

Parker A, Nagar B, Thomas G, Badri M, Ntusi NB - Cardiovasc J Afr (2011 Jul-Aug)

Bottom Line: The majority (81.2%) of the doctors surveyed had been practicing for less than 10 years.Doctors estimated that only 35% of their patients are treated to target.There are significant challenges to effective management of hypertension at this level of care.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, University of Cape Town, South Africa.

ABSTRACT

Background: Patient- and physician-related factors impact on the management and control of hypertension.

Objectives: To systematically examine: (1) South African primary care doctors' state of knowledge on the management of hypertension; (2) primary health practitioners' knowledge on the South African hypertension guidelines; (3) current approaches to management of hypertensive patients; and (4) challenges to effective management of hypertension at primary level.

Methods: A cross-sectional, observational study using a semi-structured questionnaire was carried out in two large community health centres (CHCs) in the Cape Town metropole. All 16 doctors employed at both CHCs were voluntarily enrolled, seven (43.7%) of whom were female, with 14 (87.5%) younger than 40 years of age. The majority (81.2%) of the doctors surveyed had been practicing for less than 10 years.

Results: Ten (62.5%) of the doctors surveyed aimed to treat hypertension to target, and recommendations on lifestyle modifications were reportedly poorly done. While 11 (68.8%) of the doctors were aware of the South African hypertension guidelines, were (81.8%) of them were not conversant with the contents thereof. Doctors estimated that only 35% of their patients are treated to target. Poor patient adherence to prescribed treatment, language difficulty, heavy patient load, medical staff shortages, and patient loss to follow up were identified by the doctors as significant impediments to the effective management of hypertension at the primary level of care.

Conclusion: Primary healthcare practitioners' knowledge regarding hypertension and the South African hypertension guidelines is poor. Management of hypertension by these doctors is sub-optimal. There are significant challenges to effective management of hypertension at this level of care.

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Related in: MedlinePlus

Choice of preferred antihypertensive agent, when these compelling indications are present. Angina = ischaemic heart disease or angina pectoris, PMI = previous myocardial infarct, HF = heart failure, DM = diabetes mellitus, CVA = prior cerebrovascular accident, PVD = peripheral vascular disease, Alb = albuminuria, CKD = chronic kidney disease, LVH = left ventricular hypertrophy, and JISH = just isolated systolic hypertension.
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Figure 2: Choice of preferred antihypertensive agent, when these compelling indications are present. Angina = ischaemic heart disease or angina pectoris, PMI = previous myocardial infarct, HF = heart failure, DM = diabetes mellitus, CVA = prior cerebrovascular accident, PVD = peripheral vascular disease, Alb = albuminuria, CKD = chronic kidney disease, LVH = left ventricular hypertrophy, and JISH = just isolated systolic hypertension.

Mentions: Doctors were also asked to choose from a list of four drugs (angiotensin converting enzyme inhibitor or angiotensin receptor blocker, calcium channel blocker, β-blocker or diuretic) and indicate their preferred choice of antihypertensive agent, when the following compelling indications are present: ischaemic heart disease or angina, heart failure, diabetes mellitus, prior cerebrovascular accident, peripheral vascular disease, albuminuria, chronic kidney disease, left ventricular hypertrophy, and isolated systolic hypertension. Knowledge of the compelling indications for treatment of hypertension was poor, with the majority (62.5%) of doctors not knowing what the appropriate agent of choice for these conditions should be (Fig. 2).


Health practitioners' state of knowledge and challenges to effective management of hypertension at primary level.

Parker A, Nagar B, Thomas G, Badri M, Ntusi NB - Cardiovasc J Afr (2011 Jul-Aug)

Choice of preferred antihypertensive agent, when these compelling indications are present. Angina = ischaemic heart disease or angina pectoris, PMI = previous myocardial infarct, HF = heart failure, DM = diabetes mellitus, CVA = prior cerebrovascular accident, PVD = peripheral vascular disease, Alb = albuminuria, CKD = chronic kidney disease, LVH = left ventricular hypertrophy, and JISH = just isolated systolic hypertension.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3721906&req=5

Figure 2: Choice of preferred antihypertensive agent, when these compelling indications are present. Angina = ischaemic heart disease or angina pectoris, PMI = previous myocardial infarct, HF = heart failure, DM = diabetes mellitus, CVA = prior cerebrovascular accident, PVD = peripheral vascular disease, Alb = albuminuria, CKD = chronic kidney disease, LVH = left ventricular hypertrophy, and JISH = just isolated systolic hypertension.
Mentions: Doctors were also asked to choose from a list of four drugs (angiotensin converting enzyme inhibitor or angiotensin receptor blocker, calcium channel blocker, β-blocker or diuretic) and indicate their preferred choice of antihypertensive agent, when the following compelling indications are present: ischaemic heart disease or angina, heart failure, diabetes mellitus, prior cerebrovascular accident, peripheral vascular disease, albuminuria, chronic kidney disease, left ventricular hypertrophy, and isolated systolic hypertension. Knowledge of the compelling indications for treatment of hypertension was poor, with the majority (62.5%) of doctors not knowing what the appropriate agent of choice for these conditions should be (Fig. 2).

Bottom Line: The majority (81.2%) of the doctors surveyed had been practicing for less than 10 years.Doctors estimated that only 35% of their patients are treated to target.There are significant challenges to effective management of hypertension at this level of care.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, University of Cape Town, South Africa.

ABSTRACT

Background: Patient- and physician-related factors impact on the management and control of hypertension.

Objectives: To systematically examine: (1) South African primary care doctors' state of knowledge on the management of hypertension; (2) primary health practitioners' knowledge on the South African hypertension guidelines; (3) current approaches to management of hypertensive patients; and (4) challenges to effective management of hypertension at primary level.

Methods: A cross-sectional, observational study using a semi-structured questionnaire was carried out in two large community health centres (CHCs) in the Cape Town metropole. All 16 doctors employed at both CHCs were voluntarily enrolled, seven (43.7%) of whom were female, with 14 (87.5%) younger than 40 years of age. The majority (81.2%) of the doctors surveyed had been practicing for less than 10 years.

Results: Ten (62.5%) of the doctors surveyed aimed to treat hypertension to target, and recommendations on lifestyle modifications were reportedly poorly done. While 11 (68.8%) of the doctors were aware of the South African hypertension guidelines, were (81.8%) of them were not conversant with the contents thereof. Doctors estimated that only 35% of their patients are treated to target. Poor patient adherence to prescribed treatment, language difficulty, heavy patient load, medical staff shortages, and patient loss to follow up were identified by the doctors as significant impediments to the effective management of hypertension at the primary level of care.

Conclusion: Primary healthcare practitioners' knowledge regarding hypertension and the South African hypertension guidelines is poor. Management of hypertension by these doctors is sub-optimal. There are significant challenges to effective management of hypertension at this level of care.

Show MeSH
Related in: MedlinePlus