247fairly unobtrusive, silent disease, seek out informal care providers for answers and
alleviation. Authorities in Bangladesh have acknowledged the importance in the
public sector’s struggle with an epidemic chronic disease of fostering relationships
with informal allopathic practitioners and have acknowledged efforts to standardize
information and practice among them [ 66 ].
On the whole, the key to increasing medication compliance and to sponsoring
healthier lifestyles seems to be education, whether personalized or of a population
overall. In both Pakistan and across several different Asian communities, the com-
bined effects of health education at home and a trained GP in controlling blood
pressure have been shown to have better cost-effectiveness than standard strategies
or either intervention alone, at the same time as being affordable.
Portable kiosks to distribute health information outside either the home or the
clinic have proven themselves as an effective means of health education in settings
both rural and urban [ 67 ]. An alliance of traditional and conventional means of
health care was sought in Tanzania by means of the founding of an institute of tra-
ditional medicine. These efforts and similar ones in varied developing countries
discussed by Joshi et al. [ 67 ] are widely perceived as beneficial. Closer to the formal
health-care system, pharmacists are often providers of instant BP monitoring and
advice about medication. Reports on the impact of pharmacist-provided services
suggest improvements to hypertension control and overall quality of life but only in
countries with middle-income profiles [ 68 ], potentially because of greater use of
superior guidelines concerning hypertension management in such countries and
more effective regulation and monitoring of pharmacist practice in those countries.
A high-tech intervention that takes into account the reliance upon mobile technolo-
gies in countries where many have never had home Internet or land-based phone
service is the use of cell phones to remind patients when to take their tablets. In
combination with BP monitoring performed at home according to clear step-by-step
guidance, automated management of this sort has been shown as beneficial for
hypertension outcomes [ 69 ]. A telephone-based management system, using an
automated caller to remind the patient when to take their medication and which
gives self-care management tips to each patient based on their own BP measure-
ments and diet, has been shown as beneficial in two middle-to-low-income coun-
tries in South America. These systems can even travel over the head of the patients
to contact health workers when a patient might be having excessively many high BP
readings or if they have self-reported a suboptimal level of compliance [ 69 ]. Finally,
the lack of social support shown to contribute to poor levels of compliance [ 70 ] is
addressed with weekly updates sent to a close friend or family member [ 69 ].
Unsurprisingly, the greatest reductions in blood pressure were seen among those
with lower levels of literacy and those requiring frequent communications regarding
the blood pressure – the most vulnerable groups in conventional practice in terms of
worse outcomes. This intervention seems in these ways to have hurdled the provider-
to- patient barrier in the management of hypertension. Still, like any other interven-
tion, there are gaps concerning our knowledge of the risks, acceptability, effects,
and costs over the long term [ 71 ].
15 Public Health Efforts for Earlier Resistant Hypertension Diagnosis...