Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand

Chaisiri Angkurawaranon*, Kanokporn Pinyopornpanish, Supattra Srivanichakorn, Pattara Sanchaisuriya, Bang-on Thepthien, Dusida Tooprakai, Elisha Ngetich, Albertino Damasceno, Michael Hecht Olsen, James E. Sharman, Renu Garg


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A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (<90 beds), large (90–120 beds), and provincial (>120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient's cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p <.01). The hypertension control rate at last visit was 64% but varied between 59% in community hospitals and 71% in large hospitals (p <.01). Failure to adjust medication when required was associated with 30% decrease in the odds of hypertension control (OR 0.69, 95% CI 0. 50 to 0.90). Failure to comply with the treatment guidelines regarding adjustment of medication and lost to follow-up are possible target areas to improve hypertension control in Thailand.

TidsskriftJournal of Clinical Hypertension
Udgave nummer4
Sider (fra-til)702-712
StatusUdgivet - apr. 2021

Bibliografisk note

Funding Information:
This analysis was supported by Bloomberg Philanthropies and Resolve to Save Lives, an initiative of Vital Strategies, through a grant to the National Foundation for the Centers for Disease Control and Prevention Inc (CDC Foundation). Resolve to Save Lives is funded by grants from Bloomberg Philanthropies; the Bill and Melinda Gates Foundation; and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation. We would also like to acknowledge the support of the mentorship collaboration consisting of the US Centers for Disease Control and Prevention, Resolve to Save Lives, World Hypertension League, and Lancet Commission on Hypertension Group and the World Health Organization. Finally, we would like to thank all coordinating staff from the 16 hospitals that facilitated the clinical audit.

Publisher Copyright:
© 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

Copyright 2021 Elsevier B.V., All rights reserved.


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