A multimedia program for caregivers of pediatric patients with chronic kidney disease in Guatemala

OBJECTIVES

A multimedia medication training program for parents and legal guardians of children with chronic kidney disease (CKD) aimed to improve comprehension CKD and general information about medications used in pediatric patients attending The Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City).

METHODS

A quasi-experimental study was carried out to measure the impact of the educational intervention on medication knowledge, at FUNDANIER from September to October 2019. Means and standard deviations was used to described test results. A Wilcoxon test was performed, to compare scores of pre and post-tests. Odds Ratio (OR) was used to determine if there was an improvement in the knowledge score before and after the intervention. Results There was significant improvement in knowledge scores knowledge before and after the intervention(27/35 versus 33/35, P < 0.005). Mestizo participants had higher odds of improvement before and after the intervention (OR 7, CI: 0.6-78). Parent-guardians with prior education, and who spoke Spanish had higher odds of improved knowledge scores (OR 3.2, CI:0.3-35; OR 1.1 CI: 0.1-14 respectively).

CONCLUSION

Caregivers who participated in the educational workshop improved and retained information related to CKD comprehension and medications used. This study provides a model for educational modules that can be used, tested, and applied in other chronic disease settings in low to middle income countries.

PRACTICE IMPLICATIONS

A culturally relevant multimedia CKD educational platform was effective in improving medication knowledge among parent/guardians of children with CKD in a low literacy setting.

[Analysis of direct costs of controlling arterial hypertension]

OBJECTIVE

To analyse the number of attendances and the direct cost of pharmaceutical prescription arising from a year-long monitoring of hypertense patients.

SETTING

Health Centre.

DESIGN

A prospective observation study.

PATIENTS

220 hypertense patients, undergoing arterial pressure (AP) monitoring, were chosen by means of systematic random sampling.

MEASUREMENTS AND MAIN RESULTS

The variables of age, gender, cardiovascular risk factors, AP, monitoring level (criterion AP < 160-90 mmHg), attendances and treatment used were analysed. The pharmaceutical cost was calculated in line with the dosages and according to the 1990 Vademecum. The monitoring level was 43.6%. The total number of attendances per patient were 12.8 +/- 6.43 and those for hypertension, 7.9 +/- 3.5. Diabetics attended more for hypertension (8.8 vs 7.5, p < 0.05). Pharmaceutical treatment was prescribed for 183 people (83.2%). The number of drugs was correlated with the severity of the hypertension and the number of attendances. Overall drug cost was 429,571 pesetas per month. Average monthly cost per patient was 2,348.69 +/- 2,318.92 pesetas (range 90.5-12,856.5). Angiotensin enzyme conversion inhibitors (AECI) made for the greatest monthly mean cost per patient (4,352.9 pesetas) and diuretics, the least (322.2 pesetas).

CONCLUSION

Frequency of attendance is related to the presence of diabetes and the number of drugs prescribed. The introduction of AECI and Calcium antagonists into first-line treatment represents an important increase in the cost of controlling Hypertension.

[Control of arterial hypertension: analysis of visit and time factors]

OBJECTIVE

To analyse the frequency of attendance and the time elapsed between the diagnosis of Arterial Hypertension (AHT) and the control of Arterial Pressure (AP); and to analyse the different ways of presenting the level of control of AHT.

DESIGN

Retrospective study.

SETTING

Teaching Health Centre.

PATIENTS

103 hypertense patients diagnosed since 1986: 44 men (42.7%) and 59 women (57.3%), with an average age of 52.6 +/- 1. Their initial AP was 164.4 +/- 17.1/102.1 +/- 7.4 mmHg. The criterion of AHT control was Diastolic Arterial Pressure (DAP) < 90 mmHg.

MEASUREMENTS AND MAIN RESULTS

AP at the end of the first year was 150.1 +/- 20.6/90.7 +/- 9.6 mmHg (p < 0.001 in comparison with the initial AP). The average attendances for AHT and per patient in the first year was 8.7 +/- 5 (1-26). Patients with more severe forms of AHT and/or with associated risk factors visited more often (p < 0.05). During the first year 76 patients (73.7%) presented on at least one attendance a controlled DAP. At the end of the first year 46 patients (44.6%) were under control. The average time per patient until AP was controlled was 28.6 +/- 31.6 weeks (1-168). Males and under-65s took more time to control their AP (p < 0.05).

CONCLUSIONS

There are gender and age differences in the time required to bring AP under control. Frequency of attendance is related to the severity of AHT and the presence of other pathologies and risk factors. The level of control of AHT, expressed in different ways, is not constant.

[A tumor registry at a primary care center]

AIM

We analysed the data obtained from a tumor register kept in a Primary Care Centre (PCC) to find out the variables which contribute to the diagnostic and therapeutic evolution of our patients.

DESIGN

Retrospective study on every Neoplasia registered in the Centre.

PATIENTS

293 malignant Neoplasias were recorded in the period between June 1984 and June 1990 (184 in males--62.8%; and 109 in women--37.2%).

MEASUREMENTS AND MAIN RESULTS

The intervals between symptom and consultation (ISC), between consultation and referral (ICR), between referral and diagnosis (IRD) and between diagnosis and treatment (IDT) were evaluated. The average age at the moment of diagnosis was 59 (SD:13). There were 3.9% double neoplasias. The most frequent type was lung cancer with 41 cases (14%). This also occupied first place among men, whereas breast cancer did so among women. 10 tumours were diagnosed by screening: 4 breast, 5 cervix and 1 endometrium, which represent 16%, 50% and 14.3% respectively of these cancers. For all neoplasias taken together, the average time of ISC was 44.09 days (SD 73.48) and of IDT 25.75 days (SD:61.55). Given the wide variations, we assessed the most common types of tumour.

CONCLUSIONS

The usefulness of keeping a tumour register in a Primary Care Centre, which could identify the factors which affect diagnostic delays and find possible corrective measures to reduce the delays, was appraised.