Chronic diseases management in the Jamaican setting: HOPE worldwide Jamaica's experience

The prevalence of hypertension and diabetes in Jamaica is very high. Hypertension is present in 3 out of 10 Jamaicans over the age of 30 years while the prevalence of diabetes mellitus varies between 13% and 18% for Jamaicans over 15 years. HOPE worldwide Jamaica is a 7-year-old private voluntary organization that collaborates with the government of Jamaica to provide a mobile medical service to poor rural communities. The records between January 1999 and December 1999 of 1091 chronic disease patients aged > 30 years were reviewed. The average recorded age of the patients was 64 years and 82% among them were females. 60% had hypertension, 16% had diabetes and 24% had both diabetes and hypertension. There were 2390 visits for hypertension, with an average of 2 visits per patient. 34% of patients had a blood pressure of < or = 140/90 mmHg while 43% had a blood pressure < 160/95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. 44% of the patients with hypertension were non-compliant at the time of their visit. Antihypertensive treatment included thiazide diuretics (65%), reserpine (50%), angiotensin converting enzyme (ACE) inhibitors (30%) and alpha-methyldopa (5%). There were 1122 visits for diabetes, with an average of 2 visits per patient. Among the diabetic patients 23% were controlled to a fasting blood glucose (FBG) level of less than 6.7 mmol/l and 38% to below 8 mmol/l. 30% of the diabetic patients were non-compliant at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78%), glyburide (43%) and chlorpropamide (30%). 14% of the diabetic patients were on treatment with insulin: insulin 70/30 (12%) and lente insulin (2%). Electrocardiograms (ECGs) were done in the previous two years on 267 patients (29%), among whom 38% had evidence of left ventricular hypertrophy and 16% of ischaemic heart disease. The level of blood pressure and blood glucose control was inadequate despite the provision of regular monitoring, surveillance and improved access to medication. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs and some other factors continue to militate against improved compliance and control. HOPE worldwide Jamaica is currently implementing programs to improve patient education, especially in compliance, to provide access to more effective medication with convenient once-daily dosage regimens, and to develop support groups among chronic disease patients in order to improve compliance and control.