Audit on Control of Hypertension in Al-Tawar

Clinic

• By:-• Amal Musbah• Bashayer Abdalla• Jumana Haider• Nastaran• Raghda Saeed

Index• Introduction• Aim Of Audit• Methodology• PHC Hypertensive Guidelines• Criteria • Recommendations

Definition:

• Hypertension is the term used to describe high blood pressure.

• Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body.

Definition:

• Blood pressure readings are usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.

• The top number is called the systolic blood pressure, and the bottom number is called the diastolic blood pressure.

• Normal blood pressure is when your blood pressure is lower than 120/80 mmHg most of the time.

• High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time.

Definition:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001502/

Definition:

• If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension.

• If you have pre-hypertension, you are more likely to develop high blood pressure.

Epidemiology

•National health surveys in various countries have shown a high prevalence of poor control of hypertension.

• These studies have reported that prevalence of hypertension is 22% in Canada, 26.3% in Egypt, and it is 13.6% in China. Overall, approximately 20% of the world’s adults are estimated to have hypertension.

• Out of 386 cases admitted in 2006, 147 (38.1%) were Emirati and 61.9% were Expatriates in the U.A.E, but hypertension was more prevalent among females in the age group 45-64 years and males in the age group 65 years and above.

Types of Hypertension:

•I)Primary (essential) hypertension :For most adults, there is no identifiable cause of high blood pressure. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.

•II)Secondary Hypertension:caused by other medical conditions like:

• Chronic kidney disease• Disorders of the adrenal gland

(pheochromocytoma or Cushing sydrome)• Pregnancy (preeclampsia)• Medications such as birth control pills, diet pills,

some cold medications, and migraine medications• Narrowed artery that supplies blood to the kidney

(renal artery stenosis)• Hyperparathyroidism

Aim of the audit :

To assess the level of control of blood pressure among the hypertensive patients visiting Al-Twar Clinic –

Dubai in January 2012.

Methodology

• Audit design: – Retrospective audit.

• Population : – Hypertensive Patients attending at Al-Twar Health

Center in January 2012.– 122 patients visited the health center in January, the

whole population was included in the audit.– Out of the 122, 4 patients were excluded and with some

files unavailable we ended up with 115 files to audit.– Population was obtained from the hypertension register.

• Inclusion and Exclusion Criteria:– We included All hypertensive patients

attending Al – Twar health clinic in January 2012.

– We excluded any patient diagnosed on January 2012.

Guidelines

1. Blood Pressure for Non-Diabetic Patients <140/90 mmHg

2. Blood Pressure for Diabetic Patient <130/80mmHg

• Data Collection sheet was set in a table with the following format:

• Operation definition was developed.

Patient #

Health Card #

Gender Nationality

D.O.B Age Diabetic Date of Last BP reading

Last BP reading

Conclu-sion

• Pilot study was conducted and data collection sheet was modified accordingly.

• Data collection was done on October 2012 by us.

ResultsNumbers Percentage

Age: Mean: 57.38 -

Max: 84 -

Min: 32 -

Gender: Female: 64 56%

Male: 51 44%

Nationality: Emirates: 109 95%

Other: 6 5%

Results

48%51%

Controlled/Uncontrolled

ControlledUncontrolled

Controlled Uncontrolled0

10

20

30

40

50

60

35

48

28

12

DiabeticNon-Diabetic

Recommendations

Service Improvement:-• Ensuring that screening and detection of

hypertension is provided in the medical practice.

• Health education about lifestyle management to prevent hypertension.

• Monitoring special diseases and conditions, such as diabetes, congestive heart failure, and renal dysfunction.

Recommendations

• Considering combination therapy for patients with hypertension

• Encouraging patient, family, and community activities to promote healthy lifestyles and blood pressure control

Recommendations

For the doctor :-• All hypertensive patients should be

followed by the same doctor to maintain continuity of care.

• Special clinic for hypertensive patients

Recommendations

For the patient :-

• Patients should follow the instructions given by the doctor carefully.

Causes of Insufficiency

• Workers

• Insufficient/Inconsistent information

• Handwriting

Resources

• http://www.omjournal.org/Editorial/FullText/200807/ContinuityofCareandQualityofCare.html

• http://www.businessgrouphealth.org/pub/f2f5cf61-2354-d714-51f9-0fd930afb424

• www.patient.co.uk › Diseases & Conditions

• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001502/

Thank you for your listening