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

Abstract

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.

Blood pressure—lowering medication prescribing, its adherence to guidelines and relationship with blood pressure control at a family medicine department

“…Physician preference, especially in tertiary facilities may also influence adherence to generic medication prescribing. Generally, adherence to hypertension treatment guidelines in primary and secondary care has been reported to be suboptimal 55–60 . Several studies have reported lower adherence to hypertension treatment guidelines in primary and secondary care compared to our findings, although two studies reported similar findings 55–60 .…”

“… 55 , 56 , 57 , 58 , 59 , 60 A study in Thailand reported drug treatment guideline adherence of 9%–59.7% in small community and medium sized nonreferral hospitals. 55 In primary healthcare settings, a study in South Africa found treatment guideline adherence of 56.6%. 56 These findings were corroborated by findings in district health clinics in a district in Malaysia.…”

Identification of patient-related, healthcare-related and knowledge-related factors associated with inadequate blood pressure control in outpatients: a cross-sectional study in Serbia

“…4 5 The factors associated with uncontrolled BP reported in the literature are described as patient related, medication related and healthcare system related. [6][7][8][9] The patient oriented factors include sociodemographic and clinical characteristics as well as patient's knowledge about HT. It is frequently reported that patients with HT are least knowledgeable on normal BP values and lifestyle changes during the treatment process.…”

“…The factors associated with uncontrolled BP reported in the literature are described as patient related, medication related and healthcare system related 6–9. The patient oriented factors include sociodemographic and clinical characteristics as well as patient’s knowledge about HT.…”

2022 Renal denervation therapy for the treatment of hypertension: a statement from the Thai Hypertension Society

“…Thai Hypertension Society guidelines on the treatment of hypertension also suggest using single-pill combination drugs for treating hypertension in the Thai population [ 39 ]. However, the prescription of single-pill combination drugs is extremely low in governmental hospitals of different sizes in Thailand [ 57 ]. Therefore, using single-pill combination drugs is also encouraged to improve medication adherence.…”