Management of diabetes mellitus in three settings in Jamaica

A sample of 437 diabetic patients was selected during a six week census to evaluate the quality of diabetic care in three clinics in the private and public sector in Jamaica. A comparison was also made between a dedicated hospital clinic (UHWI) and general medical clinics. The mean age ranged from 54 to 62 years. Median duration of follow up ranged from 6 to 9 years. Less than 10 percent were controlled with diet only and insulin was used more commonly at the UHWI (46 percent) than at the general clinixa (7 percent each). Sulphonylurea drugs alone or in combination with metformin were the commonest agents at the other clinics. There was no significant difference among the clinics in the proportion of patients with satisfactory blood glucose control (< 8 mmol/l post-prandial). Surveillance of hypertension was frequently done (90-98 percent). The proportion of patients treated for concurrent hypertension ranged from 25 percent at UHWI to 71 percent at Spanish Town. Less than 25 percent of hypertensive patients in all clinics had good blood pressure control (BP<140/90 mmHg).(AU)

Improving sexually transmitted disease management in the private sector: the Jamaica experience

OBJECTIVES: To improve the quality of sexually transmitted disease (STD) case management in Jamaica by providing comprehensive continuing medical education to private practitioners who manage 60 percent of all STDs on the island. METHODS: Six half-day STD seminars were presented at 3-4 month intervals and repeated in three separate geographic locations. All Jamaican practitioners received invitations. The subjects were as follows: urethritis, genital ulcer disease, HIV infection, vaginal discharge syndrome, STDs in children and adolescents, and a review seminar. The program effectiveness was evaluted with a written, self-reported pre-test and a telephone post-test that measured changes in clinical management. RESULTS: Six hundred and twenty eight practitioners attended at least one seminar. Comparing pre-versus post-test scores, there were practitioner improvement trends in all four of the general STD management categories: counseling/education (69.8-73.3 percent; P > 0.05); diagnostics/screening (57.2-71.0 percent; P = 0.042); treatment (68.3-74.5 percent; P > 0.05)l and knowledge (66.4-83.2 percent; P = 0.002). Obtaining syphilis serologies during pregnancy rose from 38.3 to 83.8 percent (P = 0.001), and providing effective treatment for gonorrhea rose form 57.8 to 81.1 percent (P = 0.002), but correct responses on treatment for mucopurulent cervicitis at the post-test was a low 32.4 percent. CONCLUSION: The introduction of contiuing medical education for improved STD care targetting private physicians in Jamaica was successful based on high attendance rates and self-reported STD management practices. However, efforts should continue to address the weaknesses found in STD management and counseling and to reach the providers who did not participate. In the global effort to reduce HIV transmission by improving STD care services. continuing education programs that target the private sector can be successful and should be included as standard activity to improve care and providee a public/private link to STD/HIV control.(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)

Health expenditures in Latin America and the Caribbean

This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average, per capita health expenditure of US$ 162. On average, the countries spent 6.2 percent of their GDP on health, with the expenditure divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health expenditure, is likely to increase rapidly, while aid dependency is likely to decline.(AU)

The dispensing function of the pharmacist in health care delivery from the perspectives of the consumers and suppliers of pharmaceuticals

Behavioural research is urgently needed to improve the way that pharmaceuticals are prescribed, dispensed and used. The level of satisfaction of the providers and consumers of pharmaceuticals with several aspects of the delivery of pharmaceutical health care, may provide information about the standards of pharmaceutical services and its limitations. Such information may be the basis on which the functions of the pharmacist are expanded and improved. The population studied was the pharmacy personnel in private retail pharmacies and public pharmacies, as well as the consumers that receive prescribed medications at these pharmacies. The results revealed that the criteria of provision of additional information and counselling was most popular among consumers and supplier in determing the efficiency of the pharmacist. A higher proportion of consumers in the public sector reportedly received this service all of the time, than consumers in private sector, and the majority of consumers and suppliers in the private and public sectors are satisfied with the amount of patient counselling that is given by pharmacist with regard to prescribed medications. There is significant association between the consumers' level of satisfaction with waiting time for prescription filling and the sector of the pharmacy. Most suppliers were satisfied with the waiting time of consumers at the pharmacies. However, most consumers and suppliers ares satisfied with the dispensing function of the pharmacist in the provision of health care and there is no significant difference in the level of satisfaction among these groups in private and public sectors. Convenient location of the pharmacy, the facilites or equipment available and their maintenance, and the courtesy and positive attitude of the pharmacist ranked high among the reasons that consumers visit the pharmacies that they do visit. The vast majority of consumers and suppliers were satisfied with the dispensing role of the pharmacist in the provision of health care. A prescription window designed specifically for patients that are interested in the availability and price of prescribed drugs, and patient counselling regarding proper use of drugs were the most popular services that consumers believe should be performed routinely by a pharmacist. The suppliers of pharmaceuticals that work in the public sector appear to be more satisfied with management than those working in the private sector. (AU)

Involvement of the private sector in response to the threat of cholera in Trinidad and Tobago

On Friday January 31st, 1992 the Trinidad and Tobago Minister of Health, the Honourable Mr. John Eckstein, informed the twin island state that "cholera is staring us in the face", following its arrival in neighbouring Venezuela. In his statement to the House of Parliament, he outlined the spread of the disease from the first cases in Peru in January 1991, to epidemics in Ecuador, Colombia, Chile, Brazil, then to the Central American countries of Mexico, Guatemala, El Salvador, Bolivia, Honduras, Nicaragua, and eventually to Venezuela with 58 cases as at January 30, 1992. Calling Venezuela "our backyard", given that it is a mere seven miles away and that there is frequent travel (legal and illegal) between the two countries, Mr. Eckstein reiterated the opinion of experts, that introduction of the disease was inevitable. He therefore placed the nation on a cholera alert and focused the Ministry's attention on containing the spread of the disease and thereby minimising its negative impact (AU)

Private sector response against the cholera treat in Trinidad and Tobago

During the first half of 1992 the threat of cholera to Trindad and Tobago prompted a strong health education effort by public authorities and the private sector. To help assess the private sector effort, the cost of cholera-related advertisements and private announcements placed in the country's two leading newspapers during January-June 1992 were received. The review indicated that an estimated TT$ 540 660 was spent on these ads and announcements, that they contributed strongly to keeping cholera prevention continuously in the public eye, and that most of the messages published were accurate, specific, and safe. The strength and success of the private contribution to cholera prevention in this case suggests that similar approaches could be applied to other health problems and to the cholera problem outside Trinidad and Tobago. Overall, the lesson appears to be that if one can find congruence between private sector motives and public health interests, then the potential prospects for a successful partnership are great (AU)

The Development of the Jamaica Burn Programme - abstract

The Jamaica Burn Unit opened at the University Hospital, Mona in mid-1986. To date, it has treated 75 patients with severe burns ranging in age from 2 to 72 years. The Unit is the brainchild of Esso Standard Oil (Jca.) Ltd. and the Dept. of Surgery, U.W.I. It constitutes the nucleus of a broader based Jamaican burn programme. The project has become a co-operative venture of the private and public sectors with the involvement of the Minsitry of Health and, through them, Project Hope. In addition to the acute 4-bed unit at Mona, the programme includes facilities for reconstructive burn surgery, the training of health professionals in the care of burns and an outreach programme for the public in prevention and first aid. A formal, post-basic course for nurses was begun in 1987 at the University Hospital and, to date, 7 nurses have completed the course including 3 from Government Hospitals. In June this year, a 3-day Symposium on burn care was attended by over 190 health professionals. An outreach programme which began officially in 1987 is to be intensified over the next 9 months with more emphasis on the media and on the rural areas. In 1987, the Jamaica Burn Programme was recognized by the Public Relations Society of Jamaica and given its highest award for community service. The programme is administered by the Jamaica Burn Management Committee, an official group of professionals from the Health and Business arenas. This group meets every 3 months and it is to them that much of the success of the programme is due (AU)

Feasibility study of private sector family planning and child care services in Grenada

Presents the results of a study of the demand for work-based family planning and day care services on an industrial estate. The methodologies were market research and financial forecasting. Potential demand for Grenada were derived from average demand expressed by Eastern Caribbean women workers previously surveyed in other islands. Data for the financial forecasts and demand estimates for family planning options and day care centre options are given