Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

BACKGROUND: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor. AIM: The aim of this project was to assess and improve the quality of primary care for hypertension. SETTING: Moshupa clinic and catchment area, Botswana. METHODS: Quality improvement cycle. RESULTS: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05) was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90) in 70% of patients was achieved. CONCLUSION: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.