Hypertension control, compliance and science

Relationship between techniques taught and practice behavior: education and clinical correlation

OBJECTIVE

This study was undertaken to determine the relationship between the time spent teaching various manual procedures in each of two different chiropractic colleges and the actual practice of those procedures in the graduate clinical environment of the doctors involved.

METHODS

A simple questionnaire instrument was constructed to assess the frequency of use of 9 different manual evaluation treatment procedures. All graduates from the two chiropractic colleges in the state of Texas who obtained their license between 1988 and 1993 were polled. Reliability was studied by polling the first 30 qualified respondents twice and was found to be acceptable. The college curriculum with respect to the techniques studied was compared with the perceived use of the various techniques by the graduates surveyed.

RESULTS

A total of 224 of 322 (70%) surveys were returned for consideration. Of these, 197 met all of the inclusion/exclusion criteria and were assessed as part of the sample. Significant differences were found between the colleges with respect to perceived practitioner use of Activator (chi 2 = 14.247, P = .004), Thompson technique (chi 2 = 57.702, P = .000), Gonstead (chi 2 = 52.173, P = .000), and flexion-distraction (chi 2 = 29.424, P = .000).

CONCLUSION

Data from this research provide evidence that a relationship does exist between manual procedures taught in two different chiropractic colleges and the perceived use of those procedures in actual clinical practice. Implications of this relationship are discussed.

Health beliefs as predictors of success of alternate modalities of smoking cessation: results of a controlled trial

The primary objective of this study was to determine whether health beliefs influenced the outcome of the three alternate modalities of reducing cigarette consumption. The study randomized volunteers either to a control group or to one of three cessation programs, using behavior modification, health education, or hypnosis. A questionnaire was used to document health beliefs, demographic characteristics, and smoking history. Blood samples were taken before and after the completion of intervention programs to measure changes in serum thiocyanate. A follow-up questionnaire was used to assess smoking behavior after 6 months. Statistically significant decreases in serum thiocyanate levels followed participation in each of the three programs. Factor analysis and reliability tests were used to identify four scales reflecting major variable dimensions in the health belief model. Significant correlations between change in serum thiocyanate and two of the scales (general health concern and perceived vulnerability) were found only for the group randomly assigned to the health education intervention program.

The effect of instruction on control of blood pressure in individuals with essential hypertension

This exploratory study examined the effect of structured teaching about essential hypertension on control of the diastolic blood pressure in individuals with a diagnosis of essential hypertension. Using the pre-test, post-test design, study participants were measured on knowledge about essential hypertension and diastolic blood pressure before and after intervention. Six hypotheses were tested, three related to control of blood pressure, and three related to knowledge about essential hypertension. There was no significant difference between the experimental and control groups on diastolic blood pressure readings at the conclusion of the study. There was a significant difference between the experimental and control groups on post-test scores on knowledge of essential hypertension. It was concluded that structured teaching had no significant effect upon control of the diastolic blood pressure. Instruction increased knowledge, but not blood pressure control.

Compliance with ocular therapy

Patient noncompliance with the physician's prescribed therapeutic regimen can present serious obstacles both to individual patient care and to the obtaining of information necessary for controlled drug trials. Unfortunately, the physician often is unable to determine whether and to what extent a patient is not complying with therapy. This article reviews the problem of patient noncompliance with particular emphasis on how and why noncompliance occurs, and methods of predicting, detecting and coping with the defaulting patient.

Improving medication compliance: a randomised clinical trial

A medical monitor which recorded the date and hour each time a medicine bottle was opened was used to evaluate a programme for improving patients' compliance with their treatment. Eighty-two patients with glaucoma who had been prescribed pilocarpine eye drops three times daily to prevent visual loss were randomised into two groups. Both groups used the medication monitor during two 20-day periods, but before the second period the experimental group were given an education and tailoring programme in an attempt to improve their compliance. Nine patients missed the second treatment period and were excluded from the analysis. The patients in the experimental group showed significantly improved compliance when compared with the control group. The numbers of missed doses were reduced by about half, as was the proportion of time that exceeded the eight-hour dose intervals. Follow-up studies are needed to determine how long the improved compliance persists, but anyone considering setting up an education and tailoring programme should recognise the extent to which therapeutic efforts are wasted because of non-compliance.