RESUMO
Data from a hypertension screening project involving 4,272 black residents of a rural southern community were analyzed to determine the effects of a set of admission-decision rules on the case load of a proposed hypertension clinic. Four decision rules were investigated: conjunctive (diastolic high or systolic high); disjunctive (diastolic and/or systolic high); additive (sum of diastolic and systolic high); and systolic only. Most information relevant to admission to treatment came from knowledge of systolic blood pressures, even though knowledge of the diastolic pressure is essential in individual diagnosis. Incremental increases in the minimum blood pressure necessary for admission to treatment from 140/90 mm Hg to 160/95 mm Hg resulted in a one-third reduction in the number of patients treated, a 24% reduction in personnel utilization per patient, and a 34% reduction in drug costs; but in an estimated 14% increase in the attack rate for morbid events in men.
Assuntos
Tomada de Decisões , Hipertensão/epidemiologia , Programas de Rastreamento , Adolescente , Adulto , Negro ou Afro-Americano , Serviços de Saúde Comunitária , Custos e Análise de Custo , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/prevenção & controle , Pessoa de Meia-Idade , Mississippi , Recursos HumanosRESUMO
Holmes County, Mississippi was the site of a pilot study to develop a community-based program to combat hypertension, the primary health problem in the rural black community. Using experience gained during the pilot program, a model was developed that computes, over a sequence of planning periods, the personnel utilization and the treatment status of the patients as functions of treatment protocols, allocations of procedures to personnel, and the additions of new patients. The model can be used to study the impact of new patients on any ambulatory care program or any health maintenance organization in which there is unusually high personnel resource utilization during a patients first visit.
