Key result
Expert panel validates 46 hypertension quality indicators for primary care management in South Africa.
Why the study?
Little is known about the actual quality of care of patients diagnosed with hypertension at the primary health care level in South Africa.
Using a formal consensus method, 46 evidence-based quality indicators were developed and deemed appropriate and feasible for monitoring hypertension management at the primary health care level in South Africa.
May inform context-specific hypertension quality monitoring in South African primary care; leaves open validation before adoption.
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. This study aimed to develop quality indicators for hypertension management at the PHC level to improve the quality of care and patient outcomes. The RAND/UCLA Appropriateness Method, comprising two rounds, was used to develop clear, appropriate, and feasible evidence-based quality indicators for hypertension. In Round 1, a 9-point scale was used by a panel of 11 members 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 2, 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 and feasible 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, and data quality in South Africa and result in more efficient use of scarce resources. This study can be replicable for improving care of other non-communicable diseases across Africa.
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Rampamba et al. (2024) studied Hypertension (n=11). RAND/UCLA Appropriateness Method was evaluated on Quality indicator statements rated appropriate and feasible (score ≥7-9 with agreement). A panel of experts rated 46 out of 102 hypertension quality indicator statements as appropriate and feasible for measuring hypertension management at the primary health care level in South Africa.
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