Hypertension in Haitians: results of a pilot survey of a public teaching hospital multispecialty clinic.

Little is known about hypertension in Haitians. We performed a pilot survey of ambulatory Haitian patients in a multispecialty clinic at a large public teaching hospital. Approximately 10% of the clinic population was of Haitian origin. Clinical data were collected on 88 consecutive Haitian patients. Of these 88, 77 (87.5%) were hypertensive (SBP > or = 140 or DBP > or = 90 mm Hg or taking antihypertensive medication). The characteristics of the hypertensive patients were: age 54.1 +/- 13.0 (s.d.) years; 27 men, 50 women; 12/64 (19%) smoked; 7/63 (11%) used alcohol. Diabetes was present in 21/77 (27%). In patients for whom height and weight were available, obesity was present in 52%. Using JNC V criteria, 18 (23%) had Stage 1, 16 (21%) Stage 2, 18 (23%) Stage 3, and 25 (33%) Stage 4 hypertension. Despite 63/77 (82%) being treated for hypertension, only 20 (26%) were controlled (< 140/< 90 mm Hg). Of those under treatment, 29 were taking one drug; 18 (two drugs); 12 (three drugs); and four (four drugs). Target organ damage was evident in 37 (48%), including coronary artery disease (8), CHF (6), chronic renal failure (15), stroke (9), and LVH by ECG (19). There was evidence of severe noncompliance in 32 (42%). We conclude that in this clinic sample, hypertension was highly prevalent and unusually severe in terms of blood pressure (BP) level, refractoriness to treatment, and target organ consequences. Further studies are indicated.

[The cost of quality assurance]. / El costo de la garantía de calidad.

This paper views quality assurance costs as appraisal costs. We used cost accounting techniques to estimate the cost of quality assurance activities in a large university affiliated Veteran Administration Medical Center. In addition to the personnel employed full-time for quality assurance activities, all other employees in or directly in support of clinical services were interviewed in order to determine the per cent of their work time devoted to specific quality assurance activities. The per cent time committed was multiplied by the salary and benefits package for each employee and the total computed for the facility. In addition, non-salary overhead expenses were estimated by multiplying the salary and fringe benefit costs to the ratio of total medical center non-personnel costs to total medical center costs. We found that 3.39 per cent of the total budget or $4,884,775 was devoted to quality assurance activities. The highest costs aside from the designated quality assurance personnel were for pharmacy, Laboratory, extended care (including nursing home), psychiatry, and nursing services. We did not attempt a formal benefit analysis. We concluded that quality assurance activities in a major medical center are not free. Careful cost accounting studies should be performed both to determine the cost of quality assurance and to identify its specific benefits.