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Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials
OBJECTIVE: To evaluate evidence from published randomised controlled trials (RCTs) for the use of task-shifting strategies for cardiovascular disease (CVD) risk reduction in low-income and middle-income countries (LMICs). DESIGN: Systematic review of RCTs that utilised a task-shifting strategy in th...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202019/ https://www.ncbi.nlm.nih.gov/pubmed/25324324 http://dx.doi.org/10.1136/bmjopen-2014-005983 |
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author | Ogedegbe, Gbenga Gyamfi, Joyce Plange-Rhule, Jacob Surkis, Alisa Rosenthal, Diana Margot Airhihenbuwa, Collins Iwelunmor, Juliet Cooper, Richard |
author_facet | Ogedegbe, Gbenga Gyamfi, Joyce Plange-Rhule, Jacob Surkis, Alisa Rosenthal, Diana Margot Airhihenbuwa, Collins Iwelunmor, Juliet Cooper, Richard |
author_sort | Ogedegbe, Gbenga |
collection | PubMed |
description | OBJECTIVE: To evaluate evidence from published randomised controlled trials (RCTs) for the use of task-shifting strategies for cardiovascular disease (CVD) risk reduction in low-income and middle-income countries (LMICs). DESIGN: Systematic review of RCTs that utilised a task-shifting strategy in the management of CVD in LMICs. DATA SOURCES: We searched the following databases for relevant RCTs: PubMed from the 1940s, EMBASE from 1974, Global Health from 1910, Ovid Health Star from 1966, Web of Knowledge from 1900, Scopus from 1823, CINAHL from 1937 and RCTs from ClinicalTrials.gov. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We focused on RCTs published in English, but without publication year. We included RCTs in which the intervention used task shifting (non-physician healthcare workers involved in prescribing of medications, treatment and/or medical testing) and non-physician healthcare providers in the management of CV risk factors and diseases (hypertension, diabetes, hyperlipidaemia, stroke, coronary artery disease or heart failure), as well as RCTs that were conducted in LMICs. We excluded studies that are not RCTs. RESULTS: Of the 2771 articles identified, only three met the predefined criteria. All three trials were conducted in practice-based settings among patients with hypertension (2 studies) and diabetes (1 study), with one study also incorporating home visits. The duration of the studies ranged from 3 to 12 months, and the task-shifting strategies included provision of medication prescriptions by nurses, community health workers and pharmacists and telephone follow-up posthospital discharge. Both hypertension studies reported a significant mean blood pressure reduction (2/1 mm Hg and 30/15 mm Hg), and the diabetes trial reported a reduction in the glycated haemoglobin levels of 1.87%. CONCLUSIONS: There is a dearth of evidence on the implementation of task-shifting strategies to reduce the burden of CVD in LMICs. Effective task-shifting interventions targeted at reducing the global CVD epidemic in LMICs are urgently needed. |
format | Online Article Text |
id | pubmed-4202019 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-42020192014-10-21 Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials Ogedegbe, Gbenga Gyamfi, Joyce Plange-Rhule, Jacob Surkis, Alisa Rosenthal, Diana Margot Airhihenbuwa, Collins Iwelunmor, Juliet Cooper, Richard BMJ Open Cardiovascular Medicine OBJECTIVE: To evaluate evidence from published randomised controlled trials (RCTs) for the use of task-shifting strategies for cardiovascular disease (CVD) risk reduction in low-income and middle-income countries (LMICs). DESIGN: Systematic review of RCTs that utilised a task-shifting strategy in the management of CVD in LMICs. DATA SOURCES: We searched the following databases for relevant RCTs: PubMed from the 1940s, EMBASE from 1974, Global Health from 1910, Ovid Health Star from 1966, Web of Knowledge from 1900, Scopus from 1823, CINAHL from 1937 and RCTs from ClinicalTrials.gov. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We focused on RCTs published in English, but without publication year. We included RCTs in which the intervention used task shifting (non-physician healthcare workers involved in prescribing of medications, treatment and/or medical testing) and non-physician healthcare providers in the management of CV risk factors and diseases (hypertension, diabetes, hyperlipidaemia, stroke, coronary artery disease or heart failure), as well as RCTs that were conducted in LMICs. We excluded studies that are not RCTs. RESULTS: Of the 2771 articles identified, only three met the predefined criteria. All three trials were conducted in practice-based settings among patients with hypertension (2 studies) and diabetes (1 study), with one study also incorporating home visits. The duration of the studies ranged from 3 to 12 months, and the task-shifting strategies included provision of medication prescriptions by nurses, community health workers and pharmacists and telephone follow-up posthospital discharge. Both hypertension studies reported a significant mean blood pressure reduction (2/1 mm Hg and 30/15 mm Hg), and the diabetes trial reported a reduction in the glycated haemoglobin levels of 1.87%. CONCLUSIONS: There is a dearth of evidence on the implementation of task-shifting strategies to reduce the burden of CVD in LMICs. Effective task-shifting interventions targeted at reducing the global CVD epidemic in LMICs are urgently needed. BMJ Publishing Group 2014-10-16 /pmc/articles/PMC4202019/ /pubmed/25324324 http://dx.doi.org/10.1136/bmjopen-2014-005983 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Cardiovascular Medicine Ogedegbe, Gbenga Gyamfi, Joyce Plange-Rhule, Jacob Surkis, Alisa Rosenthal, Diana Margot Airhihenbuwa, Collins Iwelunmor, Juliet Cooper, Richard Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials |
title | Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials |
title_full | Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials |
title_fullStr | Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials |
title_full_unstemmed | Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials |
title_short | Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials |
title_sort | task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202019/ https://www.ncbi.nlm.nih.gov/pubmed/25324324 http://dx.doi.org/10.1136/bmjopen-2014-005983 |
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