a structured record to implement the national guidelines for diabetes and hypertension care.
Daniels AR, Patel M, Biesma R, Otten J, Levitt NS, Steyn K, Martell R, Dick J.
S Afr Med J 2000; 90(1): 53-56
Abstract

Background
Guidelines to improve standards of care for hypertension and diabetes were disseminated by the National Department of Health in 1996 but have not generally 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 management 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 hypertension.

Methods
A draft of the structured record was developed at a single-pilot community health centre (CHC) in the Western Cape. Focus group discussions established the core requirements for a structured record. Process, result and structural indicators in line with the national guidelines were considered for inclusion in the draft record. This draft record was then piloted at two other CHCs. Comments from semi-structured interviews and pre- and post-test evaluation questionnaires 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 page, user-friendly format, tick-boxes to reduce writing, prompts, provision for sequential recording, target setting, and compatibility with the guidelines. The final instrument was piloted and elicited a favourable overall response.

Conclusion
The structured record simplifies the application of the guidelines and the systematic recording of processes of care. The effectiveness of the guidelines will further be evaluated in a randomised control trial using the structured record.