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.