Abstract
The objectives of this study were to evaluate patients’ attitudes towards hypertension treatment according to the chronic care model and to assess the implementation of hypertension clinical guidelines in family medicine. The cross-sectional study was carried out in two randomly selected primary health care centers (Bijeljina and Prijedor), respectively in Bosnia and Herzegovina, covering the period between March and April 2016. This study sample consists of 791 respondents with hypertension purposing to measure specific actions and quality of care for hypertensive patients. The Patient Assessment of Chronic Illness Care (PACIC) was used. Treatment for the indicators of hypertension was assessed by analyzing patients' medical charts according to the recommendations of clinical guidelines. More than half of the evaluated indicators of treatment for hypertension were documented in medical charts of 84.07% patients. The average overall PACIC score was 4.18 (SD 0.59), being an average of the separate scores of 4.19 (SD 0.57) in men and 4.17 (SD 0.60) in women. Subscale means of PACIC were as follows: patient activation 4.33, delivery system design 4.36; goal setting 4.03; problem solving 4.51; follow-up and co-ordination 3.67. No statistically significant correlations in the overall score and subscale scores were found by demographic characteristics. Non-smokers had a significantly higher overall score compared to smokers (p = 0.001). As implementation of the guidelines became stronger, the reported PACIC scores rose. Continuing the education of patients in order to achieve better health care outcomes is imperative.
Highlights
Primary health care (PHC), oriented toward family medicine (FM) model, is the point of first contact between the patients and health system, capacitated to resolve a minimum of 80% of all health problems [1]
According to World Health Organization, the probability of dying between 30 and 70 years of age from the 4 main mass non-communicable diseases (NCDs) in Bosnia and Herzegovina (BiH) is 18%, including arterial hypertension -found in 43.2% of adult people [4]
The study sample included of 791 patients accepting an interview out of 810 who were invited to participate in both PHC centers
Summary
Primary health care (PHC), oriented toward family medicine (FM) model, is the point of first contact between the patients and health system, capacitated to resolve a minimum of 80% of all health problems [1]. To strengthen the PHC, the Republic of Srpska (RS), one of two entities in Bosnia and Herzegovina implemented health care reform years ago,in accordance with the PHC Strategy. According to World Health Organization, the probability of dying between 30 and 70 years of age from the 4 main mass non-communicable diseases (NCDs) in Bosnia and Herzegovina (BiH) is 18%, including arterial hypertension -found in 43.2% of adult people [4]. The Chronic Care Model (CCM) is a framework for organizing and improving chronic illness care, based on a proactive, planned approach that incorporates patient self-care, provider, and system level interventions [19]. Application of the CCM to hypertension improves the diagnosis and management of hypertension [20]
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