EVALUATION OF A SEQUENTIAL FOLLOW-UP STRATEGY FOR HYPERTENSIVE PAPAGO INDIANS.

摘要

The purpose of the study was: (1) to implement and evaluate a follow-up intervention strategy for hypertensive patients who missed appointments and were overdue for treatment; (2) to examine the patient variables of age, sex, risk level, and distance from the clinic to assess any differentiating responses to the follow-up intervention; and (3) to apply the results of the study to improve the existing health care system.;The data described the influence of the follow-up program on patients keeping their clinic visits, as well as general aspects of patient health behavior according to the various patient variables examined. The results indicated that for this particular patient population: (1) risk level for hypertension and distance from the clinic, two variables thought to be important variables in patient health behavior, were not associated with significant differences in appointment keeping behavior; (2) the follow-up intervention strategy resulted in a significantly greater number of follow-up patients than control patients keeping the clinic visit for hypertension; and (3) most patients responded to the letter intervention follow-up strategy--relatively few patients required a visit from the field worker.;The major outcome was that at the termination of the study, almost half of the control patients (47.6%) had been lost from continued hypertension treatment compared with 14.1% of the follow-up patients. The findings also reinforce evidence cited in the literature that a continuous follow-up mechanism may be critical to the successful treatment of hypertension. As a result of the data collected, a hypertension follow-up program has been established as an integrated part of the health care delivery system. The follow-up program and possible supplementary intervention strategies are discussed, based on data from the study and the relevant literature.;The study patients were 205 hypertensive Papago Indians in south central Arizona whose health care is the responsibility of the Indian Health Service. Patients were assigned to control and follow-up groups according to a block randomization process. During the eight-month period of the study, follow-up patients who became overdue experienced the following sequential intervention strategy: Following a two-week "grace" period, a letter was sent which indicated that according to the medical records, the patient was overdue for a high blood pressure check-up or a pill refill, and should return to the clinic as soon as was convenient. If there was no response in four weeks, a second letter was sent. If after another four weeks, the patient still had not come into the clinic, a field worker was sent. Field worker intervention was limited to providing patient education and determining if there was some problem which prevented the patient from keeping the hypertension appointment.