Abstract
Assessing and Improving the Quality of Care of Hypertensive Patients Action research methodology was applied in this project which was carried out at Khoaksamroanng District (Lopburi Province) and Uthai District (Ayutthaya Province). At first, community survey was carried out at the two districts (2 subdistricts for each). It was found that the prevalence of hypertension among population aged 40 and above were 14.1%-24.6% (averagely 19.7%), and 59.8-78.5 (averagely 64.1%) of them had the history of hypertension before the survey. Among those knownn cases, 37.3%-48.5% (averagely 41.4%) had regular visits to health services during the last 3 months; and among those who had regular visits, 29.2%-46.0% (averagely 39.9%) had blood pressure below 140/90 mmHg. Among those knownn cases, 78.8% got the information about hypertension from physicians, 16.7% from health center personnels, and 8.8% from nurses. 51.8% of them got the information related to selfcare behaviors, 27.3% related to etiology and symptoms, and 24.1% related to complications. However, most of them actually have not much knownledge of the disease. 48.4% of those knownn cases had > 25 Kg/M2 . 23.3% of them smoked and 30.4% of them drank alcohol. And 54.7-61.7% of them would do nothing when they had stress. 53.4%-70.0% (averagely 62.6%) of them were first diagnosed the disease at the governmental health services, and 22.4%-37.3% (averagely 30.0%) were diagnosed at private clinics. For the first diagnosis, 49.5%-65.9% (averagely 58.4%) of them had the presenting symptom of headache; 14.0%-28.4% (averagely 23.5%) were diagnosed when they went to see doctors with other diseases; and only 1.6%-6.0% (averagely 3.9%) were detected during health checkup. 27.1%-48.0% of the patients had modification in their dietary and 10.8%-24.0% (averagely 15.3%) in physical exercise. The qualitative study found that most of the patients adjusted the dosage of antihypertensive drugs by themselves, according to their own perception. And those who could control the blood pressure were always due to the capability in weight control, salt restriction and stress management. After the situation analysis, the health services at both districts had been improved by developing standard practice guideline, information system, health education system, appointment and follow-up system, and referral system. The evaluation, after 6 month of implementation, found that 70.4%, 45.0% and 56.3% of the hypertensive patients who attended the service at Khoaksamroang Hospital, Uthai Hospital and Pho-sao-harn Health Center (Uthai District) respectively had the regular visits during these 6 months. And among those who had regular visits, 12.3%, 16.7% and 0.0 respectively had blood pressure <140/90 mmHg at every visit; and 43.9%, 44.4% and 44.4% respectively had BMI <25 Kg/M2 at every visit.
