Development of Quality Indicators for Hypertension Management at the Primary Health Care Level in South Africa

Abstract Despite many quality initiatives at the primary health care (PHC) level, little is known about the actual quality of care of patients diagnosed with hypertension in South Africa. The aim of this study was to develop quality indicators for hypertension management at the PHC level to improve the quality of care and patient outcomes. A 2-round RAND/UCLA Appropriateness Method was used to develop clear, appropriate, and feasible evidence-based quality indicators for hypertension. In round one, a 9-point scale was used by an 11-member panel to rate clarity and appropriateness of 102 hypertension quality indicator statements grouped under 9 dimensions of quality hypertension management, using an online MS Excel® spreadsheet. In round two, 9 of the same panellists discussed all indicators and rated their appropriateness and feasibility during a remote online, interactive face-to-face MS Teams® meeting. Statements rated ≥7-9 with agreement were defined as either appropriate or feasible. The panel rated 46 hypertension quality indicator statements ≥7-9 with agreement for the appropriate andfeasible measurement of the management of hypertension: monitoring (n=16), review (n=5), lifestyle advice (n=9), tests (n=7), intermediate outcomes (n=6), referrals (n=2) and practice/facility structures (n=1). No indicator statements were rated both appropriate and feasible for measuring blood pressure levels and treatment. If applied, these indicators would improve monitoring and management of patients with hypertension, patient outcomes, data quality and result in a more efficient use of scarce resources. This study can be replicable for improving care of other non-communicable diseases in South Africa and Africa.