Quality of care and cost of prescriptions for diabetes and hypertension at primary healthcare facilities in the Cape Town Metropole

Abstract

Background: Quality of care for diabetes mellitus and hypertension has been found to be suboptimal at primary health care level. There is an expectation that improving quality will require the increased utilisation of resources. This research was intended to determine the quality of care and cost of prescriptions at 10 facilities in the Cape Town Metropole.

Method: An analytical, cross-sectional study was conducted in order to relate the cost of medication to quality-of-care indicators for patients with diabetes mellitus and hypertension. Data were collected at the 10 facilities in the Cape Town Metropole over a three-month period.

Results: Quality-of-care processes were performed more often in diabetic than in hypertensive patients, i.e. determination of body mass index (BMI) 52.4% vs. 46.4%, creatinine 45.2% vs. 35.7% and cholesterol 44.5% vs. 35.4%, respectively. Nevertheless, outcome measures were better in the hypertensive patients. Targets were achieved in hypertensive vs. diabetic patients, respectively, as follows: BMI (22.2% vs.18.1%), blood pressure (39.8% vs. 28.7%), creatinine (93.2% vs. 91.4%) and cholesterol (46.8% vs. 44%). The median cost per script was R44.66 and R30.06 for diabetic and hypertensive patients with good quality-of-care scores, respectively, and R51.18 and R31.00, for those with poor quality-of-care scores.

Conclusion: The quality of care provided was poor when compared with the guideline recommendations, but was comparable to care provided in many other populations. There was no correlation between quality of care and the cost of the prescriptions.

Keywords:

• cost
• noncommunicable diseases
• primary health care
• prescriptions
• quality of care

Conflict of interest

There was no conflict of interest for any of the research investigators.

Declaration

This study was funded by the Division of Family Medicine and the University of Cape Town’s research committee.

Acknowledgements

We would like to acknowledge the Facility Managers of the ten CHCs for facilitating the data collection at their facilities. We thank Norma Bloy, the pharmacist who collected data, the reception and pharmacy staff at the ten CHCs for their assistance in the provision of folders for data collection, Dr Virginia Zweigenthal for assisting with protocol development and Gayroenisa Johnson for assisting with capturing prescriptions.