Dataset Information

Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study.

ABSTRACT:

Objectives

To evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control.

Setting

Lower Manya Krobo, Eastern Region, Ghana.

Participants

All adult hypertensive community members, except pregnant women, were eligible for inclusion in the study. We enrolled 1339 participants, 69% of whom were female. A total of 552 had a 6-month visit, and 338 had a 12-month visit.

Interventions

We report on a package of interventions where community-based cardiovascular disease (CVD) nurses were trained by FHI 360. CVD nurses confirmed diagnoses of known hypertensives and newly screened individuals. Participants were treated according to the clinical guidelines established through the project's Technical Steering Committee. Patients received three types of reminder and adherence messages. We used CommCare, a cloud-based system, as a case management and referral tool.

Primary outcome

Hypertension control defined as blood pressure (BP) under 140/90?mm Hg.

Secondary outcomes

changes in BP and knowledge of risk factors for hypertension.

Results

After 1?year of intervention, 72% (95% CI: 67% to 77%) of participants had their hypertension under control. Systolic BP was reduced by 12.2?mm Hg (95%?CI: 14.4 to 10.1) and diastolic BP by 7.5?mm Hg (95%?CI: 9.9 to 6.1). Due to low retention, we were unable to look at knowledge of risk factors. Factors associated with remaining in the programme for 12?months included education, older age, hypertension under control at enrolment and enrolment date. The majority of patients who remained in the programme were on treatment, with two-thirds taking at least two medications.

Conclusions

Patients retained in ComHIP had increased BP control. However, high loss to follow-up limits potential public health impact of these types of programmes. To minimise the impact of externalities, programmes should include standard procedures and backup systems to maximise the possibility that patients stay in the programme.

SUBMITTER: Adler AJ

PROVIDER: S-EPMC6500340 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study.

Adler Alma J AJ Laar Amos A Prieto-Merino David D Der Reina M M RMM Mangortey Debbie D Dirks Rebecca R Lamptey Peter P Perel Pablo P

BMJ open 20190402 4

<h4>Objectives</h4>To evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control.<h4>Setting</h4>Lower Manya Krobo, Eastern Region, Ghana.<h4>Participants</h4>All adult hypertensive community members, except pregnant women, were eligible for inclusion in the study. We enrolled 1339 participants, 69% of whom were female. A total of 552 had a 6-month visit, and 338 had a 12-month visit.<h4>Interventions</h4>We report on a package ...[more]

PMID: 30944139

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Project description:Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions.To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases.The study was designed as a patient-level randomized controlled trial.Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c] ? 7.5%) but could have well-controlled HTN.All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM- and HTN- focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention).Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point.Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55% female and 50% white; the mean baseline A1c was 9.1% (SD = 1%) and mean SBP was 142 mmHg (SD = 20). Eighty-two percent of scheduled interviews were conducted; 69% of intervention patients and 70% of control patients reached the 24-month time point. Expressing model estimated differences as (intervention--control), at 24 months, intervention patients had similar A1c [diff = 0.1 %, 95 % CI (-0.3, 0.5), p = 0.51] and SBP [diff =?-0.9 mmHg, 95% CI (-5.4, 3.5), p = 0.68] values compared to control patients. Likewise, DBP (diff = 0.4 mmHg, p = 0.76), weight (diff = 0.3 kg, p = 0.80), and physical activity levels (diff = 153 MET-min/week, p = 0.41) were similar between control and intervention patients. Results were also similar at the 6- and 12-month time points.In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.

Project description:BACKGROUND:Differentiated models of care (DMOC) are used to make antiretroviral therapy (ART) accessible to people living with HIV (PLHIV). In Malawi, Lighthouse Trust has piloted various DMOCs aimed at providing quality care while reducing personal and logistical barriers when accessing clinic-based healthcare. One of the approaches was community-based provision of ART by nurses to stable patients. METHODS:To explore how the nurse-led community ART programme (NCAP) is perceived, we interviewed eighteen purposively selected patients receiving ART through NCAP and the four nurses providing the community-based health care. Information obtained from them was complemented with observations by the study team. Interviews were recorded and transcribed. Data was analysed using manual coding and thematic analysis. RESULTS:Through the NCAP, patients were able to save money on transportation and the time it took them to travel to a health facility. Caseloads and waiting times were also reduced, which made patients more comfortable and gave nurses the time to conduct thorough consultations. Closer relationships were built between patients and care providers, creating a space for more open conversations (although this required care providers to set clear boundaries and stick to schedule). Patients' nutritional needs and concerns related to stigma remain a concern, while operational issues affect the quality of the services provided in the community. Considerations for community-led healthcare programmes include the provision of transportation for care providers; the physical structure of community sites (in regard to private spaces); the timely consolidation of data collected in the field to a central database; and the need for care providers to cover multiple facility-based staff roles. CONCLUSIONS:The patients interviewed in this study preferred the NCAP approach to the facility-based model of care because it saved them money on transport, reduced waiting-times, and allowed for a more thorough consultation, while continuing to provide quality HIV care. However, when considering a community-level DMOC approach, certain factors - including staff transportation and workload - must be taken into consideration and purposefully planned.

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Dataset Information

Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study.

Objectives

Setting

Participants

Interventions

Primary outcome

Secondary outcomes

Results

Conclusions

Publications

Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study.

Similar Datasets

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