The use and misuse of antihypertensive medications [abstract]

The primary aim of the study was to evaluate the use and misuse of antihypertensive medications. "Use" is defined as the stringent adherence to prescribed therapy and to the instructions of the healthcare provider. "Misuse" is the alteration of prescribed therapy by the patient, who fails to comply with/adhere to the prescribers instructions. "Non-adherence" is a form of misuse, in which the patient fails to conform to the prescribed drug regime. The methodology of this study entailed a review of primary literature, interviews with colleagues and the clinical experience of the researchers. Use, misuse, and non-adherence to antihypertensive medications are global issues. In the United States of America, 25 percent of hospital admissions are due to patients' misuse or non-adherence to medication therapy. Unfortunately, local statistics are unavailable for comparison. The study did conclude that, locally, problems do exist with the use and misuse of hypertensive medications. Management of medication therapy in the hypertensive patient can be achieved by a health-care team approach and patient education. (AU)

A psychosocial profile of absconders from a psychiatric unit of a general hospital [abstract]

OBJECTIVE: To identify the significant psychosocial variables in a cohort of absconders from a psychiatric unit of a general hospital. METHOD: This study looked at the demographic and clinical aspects of patients who absconded from a psychiatric unit (Ward 21, University Hospital of the West Indies) over an 18-month period from January 2000 to June 2001. The variables observed were age, gender, diagnosis, period of time between admission to the ward and absconding, substance abuse and rate of absconding for each month during the 18-month period. The rate of patients absconding from the unit was calculated as the number of patients who absconded divided by the total number of patients admitted for that month. RESULTS: The monthly rate of absconding for the overall period observed was 2.98 percent. Of the patients who absconded, 95 percent were male, 71 percent were within the age range 15-34 years, 52.4 percent were frequent users of marijuana, 52.4 percent absconded within the first 6 days of admission and the most common diagnosis in the cohort was substance induced psychosis (33.3 percent). CONCLUSION: Patients who absconded from Ward 21 were mainly young males who were marijuana substance abusers who absconded early in their admission to the ward. This profile has guided the design of more efficient therapeutic management programmes on the unit. (AU)

Medical practitioners views on the management of hypertension in Trinidad and Tobago

We surveyed 161 medical practitioners in Trinidad and Tobago (124 reporting private sector practice and 37 describing government health centre practice) for their views on blood pressure (BP) management. 96 percent of the respondents agreed that BP should be measured on all adults seen and 90 percent agreed that diastolic pressure should be recorded as the disappearance of sounds. There was disagreement over the level of diastolic BP at which drug treatment should be initiated: 63 percent would treat diastolic BP less than 100 mm Hg, but 35 percent would only treat diastolic BP of 110 mm Hg or higher. In private practice 31 percent preferred angiotensin converting enzyme (ACE) inhibitors as treatment for an African Caribbean man with diastolic BP 110 mm Hg, but in public clinics 41 percent preferred thiazide diuretics. ACE inhibitors wre most often preferred as treatment for an Indo-Caribbean man with diabetes and diastolic BP 110 mm Hg in both public and private practice. Doctors considered that non-compliance (66 percent), lack of education (34 percent) and unhealthy lifestyles (25 percent) were important obstacles to BP control. In private practice doctors considered patients' financial constraint to be an obstacle (58 percent), whereas in the public sector limited availablity of drugs (57 percent) was felt to be more important. Less costly and possibly, more appropriate drugs were used in public clinics.(AU)

Factors contributing to the decline in compliance with rheumatic fever prophylaxis in selected health centres in Jamaica

This survey was conducted on rheumatic fever patients from selected health centres in Jamaica, who were non-compliant with prophylaxis, in order to determine the reasons for non-compliance. A total of 57 rheumatic fever patients between the ages 9 - 40 years were investigated. The group consisted of 24 patients from Olympic Gardens Health Centre, 11 from Comprehensive Health centre, 11 from Sunrise Health Centre, 7 from Edna Manley Health Centre, 3 from Gordon Town Health Centre and 1 from Duhaney Park Health Centre. The defaulters were evaluated on their demographic profile, their knowledge about illness and prophylaxis, their attitude towards their illness and prophylaxis as well as the reasons for their lack of treatment. The findings were as follows: the majority of respondents, 63.2 percent were in the 16-25 age group, 26.3 percent were between the ages of 5 years - 15 years and 10.5 percent were between 27 years and 40 years attended. There was a slight female preponderance in the age distribution as 56.4 percent were females and 43.6 percent males. The majority of respondents, (61.4 percent) attended secondary school followed by All Age School 19.3 percent, Primary School 15.55 percent and tertiary institutions accounted for 3.5 percent of responses. The respondents were knowledgeable about their illness as well as their prophylaxis. All Knowledge scores were as follows: 59.9 percent of respondents were aware that the 'strep' germ was the causative agent of rheumatic fever. All responses for the signs and symptoms were over 70 percent with 89.7 percent of the respondents stating that joint pains was a symptom. There was general awareness of the complications of rheumatic fever. All attitude scores were positive. The Likert scale was used to assess attitude. Varying reasons were given for the lack of prophylaxis. However, the unavailability of doctors at the health centres headed the list of reasons given. This study gave some insight into the reasons for non-compliance with prophylaxis. The group studied were too small for indept conclusions. A further study in this area would be needed in order to obtain more information so that the problem could be effectively addressed. (AU)