Cargando…

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

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Adler, Alma J, Laar, Amos, Prieto-Merino, David, Der, Reina M M, Mangortey, Debbie, Dirks, Rebecca, Lamptey, Peter, Perel, Pablo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500340/
https://www.ncbi.nlm.nih.gov/pubmed/30944139
http://dx.doi.org/10.1136/bmjopen-2018-026799
_version_ 1783415934298357760
author Adler, Alma J
Laar, Amos
Prieto-Merino, David
Der, Reina M M
Mangortey, Debbie
Dirks, Rebecca
Lamptey, Peter
Perel, Pablo
author_facet Adler, Alma J
Laar, Amos
Prieto-Merino, David
Der, Reina M M
Mangortey, Debbie
Dirks, Rebecca
Lamptey, Peter
Perel, Pablo
author_sort Adler, Alma J
collection PubMed
description 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.
format Online
Article
Text
id pubmed-6500340
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-65003402019-05-21 Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study Adler, Alma J Laar, Amos Prieto-Merino, David Der, Reina M M Mangortey, Debbie Dirks, Rebecca Lamptey, Peter Perel, Pablo BMJ Open Global Health 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. BMJ Publishing Group 2019-04-02 /pmc/articles/PMC6500340/ /pubmed/30944139 http://dx.doi.org/10.1136/bmjopen-2018-026799 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Global Health
Adler, Alma J
Laar, Amos
Prieto-Merino, David
Der, Reina M M
Mangortey, Debbie
Dirks, Rebecca
Lamptey, Peter
Perel, Pablo
Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study
title Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study
title_full Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study
title_fullStr Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study
title_full_unstemmed Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study
title_short Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study
title_sort can a nurse-led community-based model of hypertension care improve hypertension control in ghana? results from the comhip cohort study
topic Global Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500340/
https://www.ncbi.nlm.nih.gov/pubmed/30944139
http://dx.doi.org/10.1136/bmjopen-2018-026799
work_keys_str_mv AT adleralmaj cananurseledcommunitybasedmodelofhypertensioncareimprovehypertensioncontrolinghanaresultsfromthecomhipcohortstudy
AT laaramos cananurseledcommunitybasedmodelofhypertensioncareimprovehypertensioncontrolinghanaresultsfromthecomhipcohortstudy
AT prietomerinodavid cananurseledcommunitybasedmodelofhypertensioncareimprovehypertensioncontrolinghanaresultsfromthecomhipcohortstudy
AT derreinamm cananurseledcommunitybasedmodelofhypertensioncareimprovehypertensioncontrolinghanaresultsfromthecomhipcohortstudy
AT mangorteydebbie cananurseledcommunitybasedmodelofhypertensioncareimprovehypertensioncontrolinghanaresultsfromthecomhipcohortstudy
AT dirksrebecca cananurseledcommunitybasedmodelofhypertensioncareimprovehypertensioncontrolinghanaresultsfromthecomhipcohortstudy
AT lampteypeter cananurseledcommunitybasedmodelofhypertensioncareimprovehypertensioncontrolinghanaresultsfromthecomhipcohortstudy
AT perelpablo cananurseledcommunitybasedmodelofhypertensioncareimprovehypertensioncontrolinghanaresultsfromthecomhipcohortstudy