Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers-a focus group study

<p>Abstract</p> <p>Background</p> <p>Audits have shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines. This study aimed to evaluate the knowledge, attitudes and practices, and the barriers faced by primary care practitioners in Barbados concerning the recommendations of available diabetes and hypertension guidelines.</p> <p>Methods</p> <p>Focus groups using a moderator's manual were conducted at all 8 public sector polyclinics, and 5 sessions were held for private practitioners.</p> <p>Results</p> <p>Polyclinic sessions were attended by 63 persons (17 physicians, 34 nurses, 3 dieticians, 3 podiatrists, 5 pharmacists, and 1 other), and private sector sessions by 20 persons (12 physicians, 1 nurse, 3 dieticians, 2 podiatrists and 2 pharmacists).</p> <p>Practitioners generally thought they gave a good quality of care. Commonwealth Caribbean Medical Research Council 1995 diabetes and 1998 hypertension guidelines, and the Ministry of Health 2001 diabetes protocol had been seen by 38%, 32% and 78% respectively of polyclinic practitioners, 67%, 83%, and 33% of private physicians, and 25%, 0% and 38% of non-physician private practitioners. Current guidelines were considered by some to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions, and kept short. Patient oriented versions of the guidelines were welcomed.</p> <p>Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines, and being unable to change habits. System barriers included lack of access to blood investigations, clinic equipment and medication; the lack of human resources in polyclinics; and an uncoordinated team approach. Patients faced cultural barriers with regards to meals, exercise, appropriate body size, footwear, medication taking, and taking responsibility for one's health; and difficulty getting time off work to attend clinic.</p> <p>Conclusions</p> <p>Guidelines need to be promoted repeatedly, and implemented with strategies to overcome barriers. Their development and implementation must be guided by input from all providers on the primary health care team.</p

Knowledge, attitudes, practices, and barriers reported by patients receiving diabetes and hypertension primary health care in Barbados: a focus group study

<p>Abstract</p> <p>Background</p> <p>Deficiencies in the quality of diabetes and hypertension primary care and outcomes have been documented in Barbados. This study aimed to explore the knowledge, attitudes and practices, and the barriers faced by people with diabetes and hypertension in Barbados that might contribute to these deficiencies.</p> <p>Methods</p> <p>Five structured focus groups were conducted for randomly selected people with diabetes and hypertension.</p> <p>Results</p> <p>Twenty-one patients (5 diabetic, 5 hypertensive, and 11 with both diseases) with a mean age of 59 years attended 5 focus group sessions.</p> <p>Patient factors that affected care included the difficulty in maintaining behaviour change. Practitioner factors included not considering the "whole person" and patient expectations, and not showing enough respect for patients. Health care system factors revolved around the amount of time spent accessing care because of long waiting times in public sector clinics and pharmacies. Society related barriers included the high cost and limited availability of appropriate food, the availability of exercise facilities, stigma of disease and difficulty taking time off work.</p> <p>Attendees were not familiar with guidelines for diabetes and hypertension management, but welcomed a patient version detailing a place to record results, the frequency of tests, and blood pressure and blood glucose targets. Appropriate education from practitioners during consultations, while waiting in clinic, through support and education groups, and for the general public through the schools, mass media and billboards were recommended.</p> <p>Conclusions</p> <p>Primary care providers should take a more patient centred approach to the care of those with diabetes and hypertension. The care system should provide better service by reducing waiting times. Patient self-management could be encouraged by a patient version of care guidelines and greater educational efforts.</p

Are primary care practitioners in Barbados following diabetes guidelines? - a chart audit with comparison between public and private care sectors

<p>Abstract</p> <p>Background</p> <p>Over 19% of the population ≥ 40 years of age in Barbados are diabetic. The quality of diabetes primary care is uncertain.</p> <p>Findings</p> <p>Charts of diabetic and hypertensive patients were randomly sampled at all public and 20 private sector primary care clinics. Charts of all diabetic patients ≥ 40 years of age were then selected. Processes of care, and quality targets for blood pressure (BP), fasting blood glucose (FBG) and glycosylated haemoglobin (HbA1c) were documented.</p> <p>252 charts of diabetic patients (125 public and 127 private) were audited. Patients had the following characteristics: mean age 64 years, female gender 61%, mean duration of diagnosis 9 years, and hypertension diagnosed 78%. Patients had an average of 4.7 clinic visits per year, 66% were prescribed metformin, 68% a sulphonylurea, 25% a statin, 21% insulin, 15% aspirin and 12% a glucosidase inhibitor. Public patients compared to private patients were more likely to be female (77% vs. 46%, p < 0.01); have a longer duration of diagnosis (11.4 vs. 6.6 years, p < 0.01), have more clinic visits per year (5.2 vs. 4.3, p < 0.01), and to be using insulin (28 vs. 15% p = 0.01). Over a 2 year period, the proportion of charts with the following recorded at least once was: BP 98%, weight 80%, FBG 76%, total cholesterol 72%, urine tested for albumin 66%, serum creatinine 62%, dietary advice 61%, exercise advice 49%, lipid profile 48%, foot examination 41%, HbA1c 33%, dietician referral 23%, retinal examination 18%, tobacco use 17%, body mass index 0%, and waist circumference 0%. Public patients were more likely to have recorded: weight (92% vs. 68%, p = < 0.01); tests for total cholesterol (78% vs. 65%, p = 0.02), albuminuria (72% vs. 59%, p = 0.03), serum creatinine (79% vs. 44%, p < 0.01), and foot examination (50% vs. 32%, p = < 0.01); dietician referral (37% vs. 8%, p < 0.01), and tobacco use (26% vs. 8%, p < 0.01). For those tested, the most recent BP was < 140/90 for 43%, HBA1c was < 7% for 28%, and FBG was < 6.7 mmol/L for 27%.</p> <p>Conclusions</p> <p>Interventions such as body mass assessment, lifestyle advice, screening for retinopathy, monitoring blood glucose control, and achieving BP and glycaemic targets need improvement.</p

Purchasing online journal access for a hospital medical library: how to identify value in commercially available products

BACKGROUND: Medical practice today requires evaluating large amounts of information which should be available at all times. This information is found most easily in a digital form. Some information has already been evaluated for validity (evidence based medicine sources) and some is in unevaluated form (paper and online journals). In order to improve access to digital information, the School of Clinical Medicine and Research at the University of the West Indies and Queen Elizabeth Hospital decided to enhance the library by offering online full text medical articles and evidence based medicine sources. The aim of this paper is to evaluate the relative value of online journal commercial products available for a small hospital and medical school library. METHODS: Three reference standards were chosen to represent the ideal list of core periodicals for a broad range of medical care: 2 Brandon/Hill selected lists of journals for the small medical library (BH and BH core) and the academic medical library core journal collection chosen for the Florida State University College of Medicine Medical Library. Six commercially available collections were compared to the reference standards and to the current paper journal subscription list as regards to number of journals matched and cost per journal matched. Ease of use and presence of secondary sources were also considered. RESULTS: The cost per journal matched ranged from US $3194 to$ 81. Because of their low subscription prices, the Biomedical Reference Collection and Proquest products were the most cost beneficial. However, they provided low coverage of the ideal lists (12 – 17% and 21–32% respectively) and contained significant embargoes on current editions, were not user friendly and contained no secondary sources. The Ovid Brandon/Hill Plus Collection overcame these difficulties but had a much higher cost-benefit range while providing higher coverage of the ideal lists (14–47%). CONCLUSION: After considering costs, benefits, ease of use, embargoes, presence of secondary sources (ACP Journal Club, DARE), the Ovid Brandon/Hill Plus Collection was the best choice for our hospital considering our budget. However, the option to individually select our own journal list from Ovid and pay per journal has a certain appeal as well

Australia\u27s health 1994 : the fourth biennial report of the Australian Institute of Health and Welfare

Australia\u27s Health is the most comprehensive and authoritative source of national information on health in Australia. Australia\u27s Health is published mid-year in even-numbered years and provides national statistics and related information that form a record of health status, service provision and expenditure in Australia

The nuclear receptors of Biomphalaria glabrata and Lottia gigantea: Implications for developing new model organisms

© 2015 Kaur et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedNuclear receptors (NRs) are transcription regulators involved in an array of diverse physiological functions including key roles in endocrine and metabolic function. The aim of this study was to identify nuclear receptors in the fully sequenced genome of the gastropod snail, Biomphalaria glabrata, intermediate host for Schistosoma mansoni and compare these to known vertebrate NRs, with a view to assessing the snail's potential as a invertebrate model organism for endocrine function, both as a prospective new test organism and to elucidate the fundamental genetic and mechanistic causes of disease. For comparative purposes, the genome of a second gastropod, the owl limpet, Lottia gigantea was also investigated for nuclear receptors. Thirty-nine and thirty-three putative NRs were identified from the B. glabrata and L. gigantea genomes respectively, based on the presence of a conserved DNA-binding domain and/or ligand-binding domain. Nuclear receptor transcript expression was confirmed and sequences were subjected to a comparative phylogenetic analysis, which demonstrated that these molluscs have representatives of all the major NR subfamilies (1-6). Many of the identified NRs are conserved between vertebrates and invertebrates, however differences exist, most notably, the absence of receptors of Group 3C, which includes some of the vertebrate endocrine hormone targets. The mollusc genomes also contain NR homologues that are present in insects and nematodes but not in vertebrates, such as Group 1J (HR48/DAF12/HR96). The identification of many shared receptors between humans and molluscs indicates the potential for molluscs as model organisms; however the absence of several steroid hormone receptors indicates snail endocrine systems are fundamentally different.The National Centre for the Replacement, Refinement and Reduction of Animals in Research, Grant Ref:G0900802 to CSJ, LRN, SJ & EJR [www.nc3rs.org.uk]