Chronic disease control and compliance - the HOPE worldwide Jamaica experience

ABSTRACT

HOPE worldwide Jamaica has provided mobile curative and preventative services to fourteen rural government clinics since 1994. The patients records of 1,091 chronic disease patients, aged>30 years between January and December 1999 were reviewed. They were all above 30 years of age with an average age of 64 years; 81 percent were female and 60 percent were hypertensive, 16 percent diabetic and 24 percent had both diabetes and hypertension. There were 2,390 visits for hypertension, with an average of 2 visits per patient. Thirty-four per cent of patients had BP of < 140/90 mmHg while 43 percent had BP < 160/95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. Forty-four per cent of hypertensive were non-compliant at the time of their visit. Anti-hypertensive treatment included thiazide diuretics (65 percent), reserpine (50 percent), ACE inhibitors (30 percent) and methyldopa (5 percent). There were 1,129 visits for diabetes, with an average of 2 visits for diabetes, with an average of 2 visits per patient. Twenty-four per cent of diabetic patients were controlled to fasting blood glucose FBG levels of <6.7 mmol/l and 38 percent controlled to (FBG) levels <8 mmol/l. Thirty per cent of diabetics were non-complaint at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78 percent), glyburide (43 percent) and chlorpropamide (30 percent). Fourteen per cent of diabetics were on treatment with insulin 70/30 (12 percent) and lente insulin (2 percent). Electrocardiograms (ECG) were done on 24 percent (n=267) of patients in the previous two years. Thirty-six percent had evidence of left ventricular hypertrophy and 15 percent had evidence of ischaemic heart disease. The level of blood pressure and blood glucose control is inadequate, despite the provision of regular monitoring, surveillance and improved access to pharmaceuticals. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs, in addition to other factors, continue to militate against improved compliance and control.(Au)