TY  - BOOK
AU  - Duka,Marve  D.
AU  - Alba,MaElinore M.
TI  - Quality improvement in the diagnosis and management of hypertension at the family medicine clinic
KW  - Hypertension
KW  - Diagnosis
KW  - therapy
KW  - Quality Improvement
N2  - BACKGROUND: Over the years, hypertension has caught attention due to the increasing morbidity and mortality it causes. At the UP-PGH Family Medicine Clinic alone, it has consistently been identified as having the most number of cases, approximating 60-75 percent of all cases since January of this year. Recently, new knowledge has come to light from a variety of sources regarding the diagnosis and management of hypertension. Because of these changes, care of hypertensives must be monitored in order to assure that quality, acceptable as well as cost-effective measures are carried out without disregarding evidence from recent studies. Methods of implementation of practice guidelines should be integrated into the clinical care setting to make certain optimal patient care. The study aims to improve the appropriateness of care in the diagnosis and management of hypertension utilizing focused group discussion with feedback.

OBJECTIVE: To improve the performance levels of appropriate diagnosis and management provided by Family Medicine residents to adult hypertensive patients at the Family Medicine Clinic using the method of chart audit and focus group discussion with feedback. Setting: Family Medicine Clinic of UP-PGH.

STUDY DESIGN: Before and after intervention study. Intervention: Focused group discussion with feedback on appropriateness of care before and after outcome measurement.

MAIN OUTCOME MEASURE: Comparison of the difference in percentage of appropriateness of care before and after intervention in the diagnosis and management of adult hypertensives in terms of 17 criteria.

RESULTS: As an initial measure, a focused group discussion was conducted in order to compare two clinical practice guidelines in the diagnosis and management of hypertension. These are the widely applied Philippine Society of Hypertension Guidelines (1995) and the recently introduced Joint National Committee 7. The main objective was to formulate criteria of standards with the residents by which to base quality of care given to adult hypertensives. Having established criteria with the study population, retrospective audit of charts prior to this activity was done. Baseline data revealed that the performance levels of first year Family Medicine residents did not reach the 80 percent set standard of care with regard to appropriateness of eliciting history, conducting physical examination staging, pharmacologic and non-pharmacologic treatment. Only appropriateness of ordering diagnostic examinations was noted to reach the set standard care at 80 percent. Charts audited after the initial focused group discussion showed similar results, with some criteria (i.e. eliciting risk factors, staging, diagnosing co-morbidities, pharmacologic treatment and advising weight reduction among obese hypertensives) indicating even less performance levels than baseline. However, after a second focused group discussion and feedback tackling barriers, necessary support measures, etc. all criteria for appropriateness of care outstandingly improved, showing statistical significance. Most criteria reached the target standard of 80 percent, except for eliciting current medications, recording vital signs (mainly BMI) and recording mean arterial pressure. However, the increase from baseline and after the first intervention was still noted to be statistically significant in these three criteria.

CONCLUSION: Performance levels improved in the diagnosis and management of adult hypertensive patients after conducting focused group discussion with feedback as strategy for ensuring good quality care
ER  -