Clinic and day hospital queues are enough to make anyone’s blood boil, and one of the main factors driving them is the blood-pressure test patients must have on every visit.
Now experts at the Wits University school of public health say a rethink of the mandatory test is urgently needed and could cut queues by 80%.
Their recommendation follows a study at eight rural clinics where they found the “vital signs” queue for tests of blood pressure, weight, temperature and pulse “led to interpersonal friction at many levels”.
Lead researcher Prof Margaret Thorogood said: “Patients argued about their position in the queue, patients complained vociferously to clinic staff about the long waits, and clinic staff argued among themselves about who should attend to the queue – a job that usually went to the most junior person.
“The electronic blood pressure machines … frequently broke due to the heavy use, and the cuffs wore out quickly and became leaky. Because the machines frequently malfunctioned, there was a tendency for nurses to ignore the readings given, assuming high readings were just an error of the machine.”
Cape Town hotel worker Thozama Ndyawe, who has been told to attend the day hospital in District Six every two weeks after being diagnosed with a chronic condition, said the researchers’ findings reflected her experience.
“I have to join at least four queues for seven hours or more irrespective of how early I get here,” said the Muizenberg resident.
“Just to have my weight recorded and have my blood pressure tested takes more than two hours before joining another queue to see a doctor. I don’t even want to talk about the queue at the pharmacy … it drives me up the wall.
“How does the recording of my weight every two weeks contribute to the management of my condition? I feel the same way about blood pressure testing. I don’t have blood pressure problems … why should I be cuffed every clinic visit?”
In their study, published in January in journal PLOS One, Thorogood and colleagues said the rollout of antiretrovirals and rocketing rates of hypertension had led to “unmanageable workloads” at clinics.
Paradoxically, they said, reducing the number of blood pressure tests would free up nurses to identify and treat hypertension patients.
Thorogood said young people had diminished risk of hypertension, and one test annually would be sufficient. Reducing the frequency of other tests from an average of seven weeks to three months or six months would halve queues.
“As the numbers of chronic disease patients continue to rise, a review of the current policy for measuring blood pressure in primary healthcare clinics becomes increasingly urgent,” she said.
Ndyawe said she would prefer to skip the health checks that meant she had to take a day off work to attend the clinic.
“I may be ignorant of what happens to my body, as I’m no medical expert, but I don’t think that it’s necessary for me to be weighed every time I come here,” she said.
Ntombentsha Silinga, who was diagnosed with hypertension a few years ago, said long queues drove her away from a clinic in Khayelitsha.
“I seriously don’t see the point of being screened every time I come here as my blood pressure has been under control for some time now,” she said.
“If I were to skip the test, that would save me about three hours, and I would be able to go to work much earlier and not have to work a half day and lose money.”
Health department spokesperson Popo Maja said the Wits findings would be studied. But he pointed out the screening programme had been introduced because it was common for patients, particularly men, to arrive at clinics with uncontrolled high-blood pressure.