Quality of bloodpressure monitoring and control in primary care in Barbados

ABSTRACT

This study evaluated the quality of bloodpressure (BP) monitoring and control among primary care attenders 30 years old and over, in Barbados. Data were collected from 1,016 clinic records, 623 (61 percent) from three government polyclinics and 393 (39 percent) from five private general practitioners' (GP) offices. Nine hundred and sixteen (90.2 percent) had BPs recorded at some time, and 89.5 percent within the preceding 18 months. The proportion with no BP measurements was higher for GP patients (16.3 percent) than for polyclinic patients (5.6 percent). GP patients were less likely (OR 0.31, 95 percent CI0.19-0.48) to have their BP measured during a clinic visit. There was a marked digit preference, with BP recordings ending in "0" or "5" in 92 percent of readings. Of 345 patients treated for hypertension, 278 (82.2 percent) had a most recent BP of o 140/90mm Hg, 168 (49.7 percent) of o 160/95mm Hg and seven patients on antihypertensive medication had no BP recordings during the period under review. Hypertensive patients attending GPs were 2.65 times (95 percent CI 1.34-5.31) more likely to have poorly controlled bloodpressures than patients attending polyclinics. Diet therapy and exercise prescriptions were not recorded in the majority of patient notes. Polyclinic and GP patients were in general prescribing the same classes of drugs although more drugs were used in an attempt to control BPs in the polyclinics. In general GPs were less rigorous than health centres in monitoring and treating hypertension, although a couple of individual GPs showed that hypertension could be well managed by them. Even without considering the significant impact of hypertension on national morbidity and mortality, the results of this audit suggest that the standards of monitoring and control of bloodpressure in primary care in Barbados are unsatisfactory for realizing the goal of reducing complications (AU)