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  1. Improving cost-effectiveness of hypertension management at a community health centre.

    Article - En anglais

    Objectives

    To describe the pattern of prescribing for hypertension at a community health centre (CHC) and to evaluate the impact of introducing treatment guidelines and restricting availability of less cost-effective antihypertensive drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control.

    Design

    Before/after intervention study.

    Setting.

    Medium-sized CHC in the Cape Flats area of Cape Town.

    Subjects

    1 084 hypertensive patients attending the CHC, who had at least two prescriptions for antihypertensive drugs during a 1-year period starting on 1 January 1992.

    Interventions

    1. Implementation of stepped-care guidelines for hypertension, specifying treatment with more cost-effective drugs and minimising drug treatment. 2. Reducing availability for routine prescribing by CHC doctors of 10 less cost-effective antihypertensive drugs or drug combinations.

    Outcome measures

    1. Mean number of drugs prescribed per patient. 2. Proportion of prescriptions for :

    • each major class of antihypertensive drug ;

    • restricted availability and freely prescribable drugs ;

    • and more and less cost-effective drugs. 3. Mean monthly cost of drugs prescribed per patient. 4. Mean blood pressure and proportion of BP readings controlled (<160/95 mmHg) or uncontrolled (= 160/95 mmHg).

    Results

    A mean of 1.7 active drugs was prescribed per patient per visit.

    The most frequently prescribed drugs were thiazide-like diuretics (44.8%), centrally acting agents (28. (...)

    Mots-clés Pascal : Hypertension artérielle, Optimisation, Coût, Antihypertenseur, Economie santé, République Sud Africaine, Afrique, Homme, Appareil circulatoire pathologie, Traitement, Chimiothérapie

    Mots-clés Pascal anglais : Hypertension, Optimization, Costs, Antihypertensive agent, Health economy, South Africa, Africa, Human, Cardiovascular disease, Treatment, Chemotherapy

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0307830

    Code Inist : 002B12B05B. Création : 27/11/1998.