Hypertension control in a rural southern community: medical care process and dropping out.

As part of the Edgecombe County High Blood Pressure Control Program, we conducted a medical record review within a private group practice to assess the interrelationships between patient characteristics, the process of medical care, and dropping out of care by hypertensive patients. Twenty-one percent of 641 randomly selected hypertensive patients did not have a clinic visit in the year before their record review date. Loss to follow-up varied from 31% for black men to 13% for white women.

The Edgecombe County High Blood Pressure Control Program: the process of medical care and blood pressure control.

As part of the Edgecombe County High Blood Pressure Control Program, a medical record review was conducted within a multispecialty private group practice in the county. The purposes of the review were to assess the relationship between the process of medical care and blood pressure control and to explore the variation in level and impact of medical care by race and sex. At the end of a three-year period, 41 percent of 628 hypertensive patients from the practice had uncontrolled diastolic blood pressure (DBP), as defined by Hypertension Detection and Follow-up Program criteria.

The Edgecombe County High Blood Pressure Control Program: III. Social support, social stressors, and treatment dropout.

In a hypertension prevalence survey of a stratified random sample of 1,000 households, 2,030 adults (aged 18 years and over) were interviewed and information on psychosocial variables collected. Among 359 hypertensives, there was a consistent relationship between indicators of difficulty in the social environment and dropout from treatment in women. Compared to those who remained in treatment, women who dropped out can be characterized as having less social support on the job, having less perceived spouse approval (if married), having a lower level of perceived access to supportive resources, and being more likely to report feeling pushed most or all of the time if they are homemakers.

Community coverage in a rural, church-based, hypertension screening program in Edgecombe County, North Carolina.

In a rural, church-based hypertension program in Edgecombe County, North Carolina, screening of the congregations was complemented by a community outreach component targeted at 18-60 year old males, a group at higher risk for untreated hypertension. Compared with its estimated frequency in the community, untreated hypertension was as common in the church congregations and somewhat less prevalent than expected among outreach screenees.

The Edgecombe County (NC) High Blood Pressure Control Program: II. Barriers to the use of medical care among hypertensives.

As the initial step in a five-year project to improve control of high blood pressure in Edgecombe County, North Carolina, a survey was conducted in 1980 to determine the prevalence of hypertension and to identify factors which might constitute barriers to the use of medical care by hypertensives. This report summarizes the findings for the 539 hypertensives identified through the baseline survey. In general, Black hypertensives reported more access problems than Whites.

The Edgecombe County High Blood Pressure Control Program: I. Correlates of uncontrolled hypertension at baseline.

To guide the planning of a multifacetted hypertension control program in Edgecombe County, North Carolina, a baseline survey of a stratified (by township) random sample of 1,000 households was conducted. All adults (greater than or equal to 18 years) were interviewed and had their blood pressures (BP) measured. Five hundred thirty-nine individuals, 27 per cent of the survey population, had diastolic BP greater than or equal to 90 mm Hg or were receiving anti-hypertensive drug therapy.

Forming a rural satellite network.

Group practices enter into a satellite program for many different reasons, the most frequent probably being an effort to expand their referral base. But establishing a successful satellite system is always difficult; either the satellite service area overlaps and intrudes into someone else's "territory" or the area in which the satellite is located has no other pre-existing medical support services of any kind, in which case a group's attempt to "fill the void" often feels like stepping into it. This latter case could have been the fate for the Tarboro Clinic had we not been fortunate enough to become involved in a unique partnership alliance to bring quality health care services to eastern North Carolina.