A community-oriented programme for rehabilitation of persons with arthritis.

A community-oriented programme for rehabilitation of persons with arthritis is described. It combines an 8-week ambulatory rehabilitation course (including patient education) at a rehabilitation institution, with long-term self-rehabilitation (at patients' homes), supervised by primary-care nurses. Sixty persons (mean age 54; 80% females) with a 13-year average duration of arthritis, were suffering pain, physical limitations, difficulties in social activities, tension and a tendency to depression. They had completed the course and a 12-month self-rehabilitation at home, and were assessed with the Arthritis Impact Measurement Scales (AIMS) questionnaire on admission to the course, at its completion and 1 year thereafter. Assessment upon completion of the course showed improvement in all areas studied. Measurements at follow-up showed that the majority carried out self-rehabilitation activities and preserved the improved functional status. The programme provided a much-needed service to arthritis sufferers living in the community, and promoted both the reorientation of institution-based rehabilitation professionals towards the community and self-rehabilitation and the cooperation between the institution and primary care.

A national programme of hypertension control using a doctor-nurse team approach: the Israel experience.

Studies in Israel in the early 1970s showed that only about one-quarter of the men and half of the women with hypertension were on treatment and only about one-quarter of the treated males and half of the treated females were under control (diastolic blood pressure < 95 mmHg). Drop-out rate averaged about 30%. To improve detection and treatment of hypertension the nurses in the family clinics of Kupat Holim were taught to work with the family physicians in a team approach. This included a more efficient appointment system, case-finding, an active follow-up system for drop-outs, better documentation of findings and active health education. Reports are sent annually to a central registry in Tel Aviv. Results are tabulated and returned to the teams. Up to December 1983, 729 family practices (35.7% of the total number) were participating, and 46,909 patients are currently under treatment. This represents about half of the expected number of hypertensives in these practices. About three-quarters of the treated men and women are under control (diastolic blood pressure < 95 mmHg). Drop-out rate has fallen to 2.1% and waiting time from 105 to 7 min.

The role of the doctor-nurse team in control of hypertension in family practice in Israel.

In the 1960s and early 1970s, only 9.4% of all hypertensives in Israel were under control, due to a low rate of detection, a high dropout rate and a low rate of patient compliance. In the past seven years, a program of screening and careful follow-up of hypertensives in over 400 community clinics has been introduced, based on the active participation of clinic nurses in addition to that of family doctors. This program has been associated with a large increase in the number of detected hypertensives, a fall in the dropout rate, and a decrease in patient waiting time. In one study of 5,541 hypertensives treated initially by a doctor alone, and then by the doctor-nurse team, the number of treated hypertensives who were under control increased from 42.1 to 84.6%. The improvement in hypertension control has paralleled the reduction in cardiovascular disease in Israel.

Control of hypertension in family practice by the doctor-nurse team.

In Israel, most hypertensives are treated by the family doctor alone. In 45 family practices, nurses were given a more active part to play in the follow-up of these patients, including measuring weight and blood pressure, giving dietary guidance, checking patient compliance and actively following up drop-outs. After two years' follow-up, of a total of 4,255 patients studied, 82.4 per cent were under control (diastolic blood pressure less than 95 mmHg) compared to 42.1 per cent at the onset of the study. The drop-out rate was 0.65 per cent.