An Experience in Applying Primary Health Care to Control Hypertension in the Poor Communities in Bangkok 1986-1987

Abstract

The prevalence of hypertension in the poor communities in Bangkok is 13.2% for the people over 30 years old. About 88% of the hypertensive did not receive adequate treatment, leading to serious complications.

The program ran between February 1986 and July 1987. The leaders of congested communities, informed about the program , would select the persons in their communities to be trained to be hypertension volunteers (H.T.V). The H.T.V.would detect the hypertensives in his community and bring them to our clinic for the first visit. For the next visit, it was not necessary for the patients to come to the clinic , the H.T..V. would collect the charges and measure the blood pressures and visit the clinic to receive the medications for their patients. The H.T.V. would receive 10 Baht/patient/visit and the patient was charged 20-40 Baht/month. The clinic, ran by this program , had a team to visit the patients whenever necessary.

Fifty-eight congested communities were participated and 92 H.T.V. were trained by the program, Only 15.2% of them worked regularly and they detected 209 hypertensive patients. The program made 48.8% of them to have an accepted level of blood pressure and 60% to be regulary treated patients. The drug used, Hydrochlorothiazide alone or plus reserpine, had the rate of side effect about 50 percent, but it was not the reason the make the patients move to other place for new treatment, because the side effects were consitderably mild.

The Primary Health Care approach in the urban poor communities could be done successfully if we concerned about the opportunity cost of health volunteers. The study revealed that the working H.T.V. could increase significantly the percentage of successful treatment. The reqimen used in this study was proved to be suitable for the hypertension control program in the poor communities.