Hypertension and Diabetes: Poor Care for Patients at Community Health Centres (Original Articles) (Report)
Public sector clinics dealing with patients with acute conditions rarely provide adequate care for those with chronic conditions or attempt to address their risk factors, and generally lack patient-centred initiatives to empower patients to become active partners in their own care. Planning to improve the way primary health care services deal with acute and chronic conditions is lacking. (1) Consequently levels of control of hypertension, with age-adjusted prevalence rates of 20-30%, and diabetes, with age-adjusted prevalence rates of 4-10%, are poor, leading to high rates of complications. (2,3) Most people with hypertension and diabetes in South Africa receive treatment in the public health care system, and in Cape Town they attend the community health centres (CHCs). These are known to have deficiencies in levels of care, (4,5) with a high prevalence of unrecorded diabetic complications, suboptimal glycaemic and blood pressure (BP) control, ‘routinised’ care and polypharmacy. (4) Despite improvements in frequency of BP measurement, follow-up and compliance, hypertension has been found to be uncontrolled in approximately 50% of patients. (5) We surveyed patients with diabetes and those with hypertension attending CHCs to identify their treatment status and audited the clinic records to assess the recorded responses of health care providers in managing their patients. In-depth interviews with doctors and nurses investigated their experiences in working at the CHCs.