Hypertension And Surgery Study: Evaluating the Implementation of a Hypertension Guideline Protocol (HASS-2)
Hypertension And Surgery Study 2: A Multicentre, Cross-sectional Quality Improvement Project: Evaluating the Implementation of a Hypertensive Guideline Protocol by Perioperative Clinicians.
研究概览
地位
详细说明
Globally, cardiovascular disease is the leading cause of death. Hypertension is the commonest risk factor underlying cardiovascular disease, and, uncontrolled, is a risk for myocardial infarction, heart failure, stroke and renal disease. Hypertension is common, affecting over 1 billion people worldwide. In modern practice, failure to treat hypertension is regarded as poor medicine, and potentially indefensible.Hypertension remains a global health problem and one that is usually identified and treated in the primary health care setting. However, in South Africa, which is a resource-limited environment, it can burden an already strained primary health care system. The prevalence of hypertension in the adult population of South Africa is approximately 30%. With urbanisation, an ageing population, amongst other developing trends, this number is projected to increase significantly in the future.The perioperative period therefore presents a unique opportunity for clinicians to identify, educate and appropriately initiate or escalate management of these patients, thereby alleviating the burden on the primary health care system.
A short-term quality improvement intervention has the potential to improve quality of care in cardiovascular disease, in a low- to middle-income country like South Africa. This can be done by educating health care providers and implementing a guideline which will lead to improved, standardised and sustained quality of care for patients with hypertension. This will lead to a reduction in blood pressure, and further improve long-term morbidity and mortality of patients, and ultimately reduce the burden on an already strained health care system. Such guidelines could be modified to address other public health care challenges.
Within the African context, South Africans are recognised as being at a significant risk of cardiovascular disease, with the population having the highest prevalence of smoking, dyslipidemia, elevated fasting glucose and abdominal obesity, features of metabolic syndrome.
Metabolic syndrome found in hypertensive patients increases their risk of morbidity and mortality. This, in addition to the added physiological stress of surgery, may dramatically increase cardiovascular risk and complications in this cohort.
Prescribed medications for chronic conditions such as hypertension require a consistent level of patient compliance to the treatment regime. Compliance has been defined as "the extent to which a person's behaviour (in terms of taking medications, following diets or executing lifestyle changes) coincides with medical or health advice". Non-compliance can result in significant implications for not only the patient's health outcomes, but a considerable wastage of resources in an already limited setting. The World Health Organisation has highlighted the considerable economic and health benefits associated with improving compliance with treatments for conditions such as diabetes, hyperlipidaemia and hypertension. Similar to other non-communicable diseases, the ultimate goal of managing hypertension is achieve target control and prevent complications.The secondary aim of the HASS-2 study is to quantify the rates of compliance to antihypertensive medication following discharge from the patient's respective hospitals.
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
学习地点
-
-
Western Cape
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Cape Town、Western Cape、南非、7599
- Mitchells Plain Hospital
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Cape Town、Western Cape、南非、7599
- Somerset Hospital
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Cape Town、Western Cape、南非、7599
- Victoria Hospital
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Cape Town、Western Cape、南非、7599
- Groote Schuur Hospital
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George、Western Cape、南非、7599
- George Hospital
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Paarl、Western Cape、南非、7599
- Paarl Hospital
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Worcester、Western Cape、南非、7599
- Worcester Hospital
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-
参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Adult (older than 18 years)
- Elective surgery at preoperative in-hospital visit
- All stage 1 and stage 2 hypertensive patients as defined by the South African Hypertension Practice Guideline 2014
Exclusion Criteria:
- Patient refusal
- Day case surgery
- Obstetric and cardiac surgery
- Patients with severe hypertension (>180/110 mmHg) as defined by the South African Hypertension Practice Guideline 2014
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:不适用
- 介入模型:单组作业
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
其他:Hypertensive patients
Newly diagnosed or poorly controlled hypertensive patients will be initiated on appropriate therapy as per a specific algorithm.
|
Patients with stage 1 hypertension will receive monotherapy and risks of hypotension are negligible. A single antihypertensive lowers blood pressure (BP) on average by 10/5 mmHg. Patients with stage 2 hypertension will be initiated on two medications and this is recommended by all international hypertension guidelines and studies have shown prompt BP control with minimal side effects. For borderline patients, the investigators will elect to not treat them for blood pressure ranges of BP: 135-140/85-90 mmHg and give them a letter on discharge to be followed up at their local clinic. The letter will detail that they are potentially hypertensive patients and need to be followed up closely in future. Patients with Stage 3 hypertension will be referred to the in-hospital physician as per the algorithm. |
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Assessing physician compliance with prescription of in-hospital drugs according to hypertension algorithm
大体时间:Five day period
|
Number of participants who have drugs prescribed in-hospital
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Five day period
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Assessing physician compliance with prescription of discharge drugs according to hypertension algorithm
大体时间:Five day period
|
Number of participants who have drugs prescribed at hospital discharge
|
Five day period
|
其他结果措施
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Assessing patient compliance with antihypertensive medication dispensing following discharge.
大体时间:Three and six months following discharge.
|
Number of participants who have drugs dispensed following hospital discharge
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Three and six months following discharge.
|
合作者和调查者
调查人员
- 研究主任:Bruce Biccard, MD, PhD、University of Cape Town
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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