This is the second of a two part article on a problem based approach to insomnia. The first article provided the general practitioner with the background and methodology of the guideline formulation process. It also included recommendations on diagnosis and differential diagnosis of insomnia. In this article, the guideline covers recommendations on the diagnostic and therapeutic options for patients with insomnia. © 2003 Blackwell Publishing Asia and Wonca
Background: Insomnia is noted to occur in 10-40% of patients seen in primary care practice. It has a number of daytime consequences and affects quality of life. Furthermore, it may herald an underlying psychiatric or other medical comorbidity. As such, any primary care physician should be equipped with a simple problem-based approach for this problem. Methods: A technical research committee of the Department of Family and Community Medicine-Family Medicine Research Group of the Philippine General Hospital developed recommendations after performing a thorough review of the medical literature using a Medline search. Articles retrieved were appraised and validated and used as evidence for the various recommendations made.Recommendations: This is the first of a two part article. In this article, the guideline covers recommendations on the definition and differential diagnosis. In the second article, diagnostic examinations and therapeutic options for patients with insomnia will be covered.
BACKGROUND: Workers, including those in the healthcare industry, are exposed to occupational hazards that interfere with the health-disease process, negatively impacting their physical,[1] mental, and social health. [2] High blood pressure (HBP) is an important risk factor for cardiovascular disease and mortality of people in full productive capacity.[3] It is possible to assume that hypertensive patients who work in hospitals are more aware of the causes and complications related to hypertension, as well as about ways of prevention and treatment. Despite this assumption, there is a scarcity of studies looking at the level of adherence of Filipino healthcare workers in taking their antihypertensive medication OBJECTIVE: The study assessed antihypertensive treatment adherence and associated factors in healthcare workers from Jose R. Reyes Memorial Medical Center. METHODS: This is a retrospective analytic study design, consisting of 250 workers who self-reported as being hypertensive. Associations between sociodemographic, work, and health variables were assessed regarding adherence. The Morisky Medication Adherence Scale-8 (MMAS-8) was chosen for the study. RESULTS: Sixty % of participants were classified as controlled hypertensive patients, with 60% taking ARBs and 55.20% taking CCBs; from these, 84.80% of workers adhered to medication treatment. Adherence to pharmacological treatment has no significant association with BP control (p >.05). "Missing medical appointments" presented a statistically significant association with non-adherence to treatment. There was a greater chance (OR=5.85; p=0.005) of professionals who missed medical appointments not adhering to treatment, compared to those who reported not missing them. CONCLUSIONS: The main factors for non-adherence to treatment by workers were the presence of antihypertensive treatment disruption and missing medical appointments. Since hypertension and other cardiovascular diseases are asymptomatic diseases that require continuous treatment, hypertensive patients have difficulties understanding the importance of adhering to treatment.
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