A 4-year evaluation of blood pressure management in Trinidad and Tobago.

This paper reports a 4-year evaluation of government primary care services in Trinidad and Tobago. The sample included 16 primary care health centres in Trinidad and Tobago with cross-sectional surveys of adult attenders in 1994 and 1998. Data were obtained from clinic records including details of processes of care, drug utilisation and blood pressure (BP) control. Intervention following the initial survey was by means of reports to the Ministry of Health and annual training workshops for medical officers. Data were analysed for 1759 adult attenders at study clinics (981 in 1994 and 778 in 1998). Most attenders had blood pressure recorded (96% in 1994 and 98% in 1998). Among 1176 subjects with hypertension (BP > or =160/95 mm Hg or treated with drugs) the proportion with dietary advice ever recorded increased from .139/662 (21%) in 1994 to 185/514 (36%) in 1998, and recording of exercise advice increased from 36 (5%) in 1994 to 99 (19%) in 1998. Among subjects treated with drugs, use of Brinerdin decreased from 191/625 (31%) in 1994 to 29/486 (6%) in 1998, while use of diuretics, beta-blockers, calcium antagonists and ACE inhibitors increased. The proportion of patients with blood pressure adequately controlled (<160/95 mm Hg) was 338 (51%) in 1994 and 297 (58%) in 1998 (odds ratio 1.39, 95% confidence interval 0.96 to 2.00). An audit study used to inform health care policy, staff training and clinical practice may contribute to improving processes of hypertension management in a middle-income country like Trinidad and Tobago.