A structured record to implement the national guidelines for diabetes and hypertension care

Background. Guidelines to improve standards of care for hypertension and di abetes were disseminated by the National Department of Health in 1996 but h ave generally not been implemented by health professionals in local primary care. A strategy for the adoption and implementation of the Guidelines was developed in collaboration with health professionals in primary care. Objectives. The development of a structured record, with prompts for the ma nagement of diabetes and hypertension according to the Guidelines. Setting. Three community health centres (CHCs) in the Western Cape. Participants. Doctors and nurses managing patients with diabetes and hypert ension. Methods. A draft of the structured record was developed at a single-pilot C HC in the Western Cape. Focus group discussions established the core requir ements for a structured record. Process, result and structural indicators i n line with the national Guidelines were considered for inclusion in the dr aft record. This draft record was then piloted at two other CHCs. Comments from semi-structured interviews and pre- and post-test evaluation questionn aires were used to compile the final instrument. Results. Eleven doctors and 8 nurses participated in the development of the final instrument. Important considerations in the design were a single-pag e, user-friendly format, tick-boxes to reduce writing prompts, provision fo r sequential recording target setting, and compatibility with the Guideline s. The final instrument was piloted and elicited a favourable overall respo nse. Conclusion. The structured record simplifies the application of the Guideli nes and the systematic recording of processes of care. The effectiveness of the Guidelines will he evaluated further in a randomised control trial usi ng the structured record.