Quality of hypertension management in public primary care clinics in Malaysia: An update

Adequate control of hypertension is a global challenge and is the key to reduce cardiovascular disease risk factors. This study evaluates management of hypertensive patients in primary care clinics in Malaysia. A cross-sectional analysis of 13 784 medical records from 20 selected public primary care...

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Bibliographic Details
Published in:PloS one 2020-08, Vol.15 (8), p.e0237083-e0237083
Main Authors: Teh, Xin Rou, Lim, Ming Tsuey, Tong, Seng Fah, Husin, Masliyana, Khamis, Noraziani, Sivasampu, Sheamini
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antihypertensive agents
Antihypertensives
Blood pressure
Body mass index
Cardiovascular diseases
Care and treatment
Clinical outcomes
Counseling
Developing countries
Diabetes
Diabetes mellitus
Disease
Female
Health care
Health risks
Hospitals, Public - standards
Hospitals, Public - statistics & numerical data
Humans
Hypertension
Hypertension - epidemiology
Hypertension - therapy
Laboratories
LDCs
Low income groups
Malaysia
Male
Management
Medical care quality
Medical records
Medicine and Health Sciences
Methods
Middle Aged
Patients
People and Places
Prescription drugs
Primary care
Primary health care
Primary Health Care - standards
Primary Health Care - statistics & numerical data
Proteinuria
Public health
Public sector
Quality management
Quality of Health Care
Regression analysis
Risk analysis
Risk factors
Risk management
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Summary:Adequate control of hypertension is a global challenge and is the key to reduce cardiovascular disease risk factors. This study evaluates management of hypertensive patients in primary care clinics in Malaysia. A cross-sectional analysis of 13 784 medical records from 20 selected public primary care clinics in Malaysia was performed for patients aged ≥30 years old who were diagnosed with hypertension and had at least one visit between 1st November 2016 and 30th June 2019. Multivariable logistic regression adjusted for complex survey design was used to determine the association between process of care and blood pressure (BP) control among the hypertensive patients. Approximately 50% of hypertensive patients were obese, 38.4% of age ≥65 years old, 71.2% had at least one comorbidity and approximately one-third were on antihypertensive monotherapy. Approximately two-third of the hypertensive patients with diabetic proteinuria were prescribed with the appropriate choice of antihypertensive agents. Approximately half of the patients received at least 70% of the target indicated care and 42.8% had adequately controlled BP. After adjusting for covariates, patients who received counseling on exercise were positively associated with adequate BP control. Conversely, patients who were prescribed with two or more antihypertensive agents were negatively associated with good BP control. These findings indicated that BP control was suboptimal and deficient in the process of care with consequent gaps in guidelines and actual clinical practices. This warrants a re-evaluation of the current strategies and approaches to improve the quality of hypertension management and ultimately to improve outcome.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0237083