Assessment of the Quality of Care Provided To Ambulatory Hypertensive Patients at Dil Chora Hospital, Dire Dawa, Eastern Ethiopia

Abstract

Background; Hypertension is the most important modifiable risk factor for coronary heart disease, stroke, heart failure, and end-stage renal disease. Despite evidence of reduced morbidity and mortality by treating hypertension to specific targets, treatment in many settings is not very successful at achieving blood pressure control and meeting these targets. While access and affordability of therapy certainly play a role, another potential explanation is poor quality of care. Objective; To assess the quality of care provided to hypertensive patients and determine independent predictors of optimal quality of care at Dil Chora referral hospital, Dire Dawa, Eastern Ethiopia. Methodology; a hospital based cross sectional retrospective study was conducted to assess the quality of care provided to hypertensive patients at Dil Chora referral hospital. Using a non probability convenience sampling technique 282 hypertensive patients were selected for the study. Data was entered and analyzed using SPSS version 21 for windows. Outcome measurement for each participant was the achievement of the recommended care process, goal blood pressure and experience of the patient with the care service. And outcome measurement for the health care structure was the achievement of each structural indicator. Result; among 282 participants of the study 168(59.6%) were female and the mean age was 57.56 (±12.14). The hospital achieved 70.6% of the recommended care structure. On average patients achieved 17.06% (±8.20) of the recommended care process. Optimal quality of BP control was achieved for 93(33%) of patients. Patients with lower educational status (B=1.492, 95% CI, 0.859-2.717), fewer or no history of hospitalization (B=1.693, 95%CI, 0.732-2.653), less frequent hospital visit (B=1.363, 95%CI, 1.00-1.726) and taking single antihypertensive (B=-2.419, 95%CI,-4.171--0.666) and fewer concomitantly used medications (B=3.571, 95%CI, 2.779-4.363) are likely to achieve, on average, less recommended care processes. Hypertensive patients with co-morbid diabetes are three times more at risk of sub-optimal BP control (AOR 3.2, (95% CI, 1.23-8.325) than hypertensive patients with no comorbidity. And patients with male gender (B=-4.654 95% CI, -7.979--1.328), younger age (B=1.722 95% CI, 0.548-2.896), urban residence (B=11.250 95% CI, 4.805-17.695) and with more frequent history of hospitalization (B=-6.064 95% CI, -8.117--4.010) are likely to score, on average, less on their experience of the care service. Conclusions and recommendation: This study found that the quality of care provided to hypertensive patients in the study hospital was very low. The findings of this study showed that quality of care as measured by achievement of structural standards and patient experience is relatively better and quality of care as measured by level of health care process achievement and level of BP control was very low. Future researches on quality of care for hypertensive patients in other hospitals should also be conducted so that unsought quality gaps during patients routine counseling and clinical evaluations at follow up visits will be identified