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Adejumo OA, Mutagaywa R, Akumiah FK, Akintunde AA. Task Sharing and Task Shifting (TSTS) in the Management of Africans with Hypertension: A Call For Action-Possibilities and Its Challenges. Glob Heart 2024; 19:22. [PMID: 38404613 PMCID: PMC10885825 DOI: 10.5334/gh.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Hypertension is a leading cause of mortality globally and one of the most common risk factors for cardiovascular disease. Diagnosis, awareness, and optimal treatment rates are suboptimal, especially in low- and middle-income countries, with attendant high health consequences and grave socioeconomic impact. There is an enormous gap between disease burden and physician-patient ratios that needs to be bridged. Task sharing and task shifting (TSTS) provide a viable temporary solution. However, sociocultural, demographic, and economic factors influence the effective uptake of such interventions. This review discusses the dynamics of TSTS in the African context looking at challenges, feasibility, and approach to adopt it in the management of hypertension in Africa.
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Affiliation(s)
| | - Reuben Mutagaywa
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Tanzania
- Muhimbili Orthopedic Institute, Tanzania
| | - Florence Koryo Akumiah
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Ghana
- National Cardiothoracic Centre, Korle Bu, Ghana
| | - Adeseye Abiodun Akintunde
- Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology and LAUTECH Teaching Hospital, Ogbomoso, Nigeria
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Chan KY, Srivastava N, Wang Z, Xia X, Huang Z, Poon AN, Reidpath DD. A systematic review and meta-analysis of the effectiveness of hypertension interventions in faith-based organisation settings. J Glob Health 2023; 13:04075. [PMID: 37830137 PMCID: PMC10570758 DOI: 10.7189/jogh.13.04075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Background Hypertension is the global, leading cause of mortality and is the main risk factor for cardiovascular disease. Community-based partnerships can provide cost-saving ways of delivering effective blood pressure (BP) interventions to people in resource-poor settings. Faith-based organisations (FBOs) prove important potential health partners, given their reach and community standing. This potential is especially strong in hard-to-reach, socio-economically marginalised communities. This systematic review explores the state of the evidence of FBO-based interventions on BP management, with a focus on randomised controlled trials (RCTs) and cluster RCTs (C-RCTs). Methods Seven academic databases (English = 5, Chinese = 2) and grey literature were searched for C-/RCTs of community-based interventions in FBO settings. Only studies with pre- and post-intervention BP measures were kept for analysis. Random effects models were developed using restricted maximum likelihood estimation (REML) to estimate the population average mean change and 95% confidence interval (CI) of both systolic and diastolic blood pressure (SBP and DBP). The overall heterogeneity was assessed by successively adding studies and recording changes in heterogeneity. Prediction intervals were generated to capture the spread of the pooled effect across study settings. Results Of the 19 055 titles identified, only 11 studies of fair to good quality were kept for meta-analysis. Non-significant, average mean differences between baseline and follow-up for the intervention and control groups were found for both SBP (0.78 mm of mercury (mmHg) (95% CI = 2.11-0.55)) and DBP (-0.20 mm Hg (95% CI = -1.16 to 0.75)). Subgroup analysis revealed a significant reduction in SBP of -6.23 mm Hg (95% CI = -11.21 to -1.25) for populations with mean baseline SBP of ≥140 mm Hg. Conclusions The results support the potential of FBO-based interventions in lowering SBP in clinically hypertensive populations. However, the limited evidence was concentrated primarily in Christian communities in the US More research is needed to understand the implications of such interventions in producing clinically meaningful long-term effects in a variety of settings. Further research can illuminate factors that affect success and potential expansion to sites outside the US as well as non-Christian FBOs. Current evidence is inadequate to evaluate the potential of FBO-based interventions in preventing hypertension in non-hypertensive populations. Intervention effects in non-hypertensive population might be better reflected through intermediate outcomes.
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Affiliation(s)
- Kit Yee Chan
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
| | - Noori Srivastava
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington DC, USA
| | - Zhicheng Wang
- China Development Research Foundation, Beijing, China
| | - Xiaoqian Xia
- London School of Hygiene & Tropical Medicine, London, UK
| | - Zhangziyue Huang
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Adrienne N Poon
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington DC, USA
| | - Daniel D Reidpath
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Akintunde AA, Mutagaywa R, Manmak M, Oguntade AS, Adejumo OA, Isiguzo G, Beheiry H, Doku A, Dzudie A, Damasceno A, Onwubere BJC, Odili A, Adeoye A, Mbulaje L, Lamin ES, Akumiah F, Avorkliya L, Ogola E, Ayoola Y, Marwa S, Exon A, Amaechi UM, Okereke CJ, Nwude IE. Task sharing in the management of hypertension: highlights of the African hypertension school for nonphysicians health workers. J Hypertens 2023; 41:1544-1550. [PMID: 37642589 DOI: 10.1097/hjh.0000000000003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Abiodun A Akintunde
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Reuben Mutagaywa
- Muhimbili Orthopedic Institute & Muhimbili University of Health and Allied Sciences
| | - Manven Manmak
- Department of Medicine, University of Abuja, Nigeria
| | - Ayodipupo S Oguntade
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Big Data Institute
| | - Oluseyi A Adejumo
- Department of Internal Medicine University of Medical Sciences, Ondo State
| | - Godsent Isiguzo
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital
| | - Hind Beheiry
- Department of Physiology, Director of Educational Development and Research Centre
| | - Alfred Doku
- University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Anaestase Dzudie
- Department of Internal Medicine and Subspecialties, Douala General Hospital, Douala
| | | | | | - Augustine Odili
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, Main Campus, University of Abuja, off Airport Road, Abuja
| | - Abiodun Adeoye
- Cardiovascular Genomic Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lucia Mbulaje
- Queen Elizabeth Central Hospital, Box 95, Blantyre Malawi
| | - E S Lamin
- Department of Internal Medicine, Edward Francis Small Teaching Hospital/School of Medicine & Allied Health Sciences, University of the Gambia Banjul, The Gambia
| | - Florence Akumiah
- National Cardiothoracic Centre
- Dept of Medicine and Therapeutics, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Loius Avorkliya
- Dept of Medicine and Therapeutics, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Elijah Ogola
- Department of Medicine, University of Nairobi, Kenya
| | - Yekeen Ayoola
- Federal Teaching Hospital Gombe /Gombe State University, Gombe, Nigeria
| | | | - A Exon
- Muhumuliza Healthcare Polyclinic, Dar Es Salaam, Tanzania
| | - Uzochukwu M Amaechi
- Department of Human Resources, Society for Public Health and Social Development, Lugbe
| | | | - Ifeanyi E Nwude
- Department of Business Development and Communication, Society for Public Health and Social Development, Lugbe, Abuja, Nigeria
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Adejumo OA, Ogundele OA, Mamven M, Otubogun FM, Junaid OA, Okoye OC, Oyedepo DS, Osunbor OA, Ngoka SC, Enikuomehin AC, Okonkwo KC, Akinbodewa AA, Lawal OM, Yusuf S, Okaka EI, Odu J, Agogo E, Osi K, Nwude I, Odili AN. Physicians' perception of task sharing with non-physician health care workers in the management of uncomplicated hypertension in Nigeria: A mixed method study. PLoS One 2023; 18:e0291541. [PMID: 37756324 PMCID: PMC10529560 DOI: 10.1371/journal.pone.0291541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Task sharing and task shifting (TSTS) in the management of hypertension is an important strategy to reduce the burden of hypertension in low-and middle-income countries like Nigeria where there is shortage of physicians below the World Health Organization's recommendations on doctor-patient ratio. The cooperation of physicians is critical to the success of this strategy. We assessed physicians' perception of TSTS with non-physician health workers in the management of hypertension and sought recommendations to facilitate the implementation of TSTS. MATERIALS AND METHODS This was an explanatory sequential mixed method study. TSTS perception was assessed quantitatively using a 12-item questionnaire with each item assigned a score on a 5-point Likert scale. The maximum obtainable score was 60 points and those with ≥42 points were classified as having a good perception of TSTS. Twenty physicians were subsequently interviewed for in-depth exploration of their perception of TSTS. RESULTS A total of 1250 physicians participated in the quantitative aspect of the study. Among the participants, 56.6% had good perception of TSTS in the management of hypertension while about two-thirds (67.5%) agreed that TSTS program in the management of hypertension could be successfully implemented in Nigeria. Male gender (p = 0.019) and working in clinical settings (p = 0.039) were associated with good perception. Twenty physicians participated in the qualitative part of the study. Qualitative analysis showed that TSTS will improve overall care and outcomes of patients with hypertension, reduce physicians' workload, improve their productivity, but may encourage inter-professional rivalry. Wide consultation with stakeholders, adequate monitoring and evaluation will facilitate successful implementation of TSTS in Nigeria. CONCLUSION This study showed that more than half of the physicians have good perception of TSTS in hypertension management while about two-thirds agreed that it could be successfully implemented in Nigeria. This study provides the needed evidence for increased advocacy for the implementation of TSTS in the management of hypertension in Nigeria. This will consequently result in improved patient care and outcomes and effective utilization of available health care personnel.
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Affiliation(s)
| | | | - Manmak Mamven
- Department of Internal Medicine, University of Abuja, Gwagwalada, Nigeria
| | | | | | | | | | | | - Stanley Chidozie Ngoka
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo State, Nigeria
| | | | | | | | | | - Shamsuddeen Yusuf
- Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano State, Nigeria
| | | | - Joseph Odu
- Resolve to Save Lives Organization, Nigeria
| | - Emmanuel Agogo
- Department of Internal Medicine, University of Medical Sciences, Ondo State, Nigeria
| | - Kufor Osi
- Resolve to Save Lives Organization, Nigeria
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Ogungbe O, Cazabon D, Moran AE, Neupane D, Himmelfarb CD, Edward A, Pariyo GW, Appel LJ, Matsushita K, Hongwei Z, Tong L, Dessie GA, Worku A, Choudhury SR, Jubayer S, Bhuiyan MR, Islam S, Osi K, Odu J, Obagha EC, Ojji D, Huffman MD, Commodore-Mensah Y. Landscape of team-based care to manage hypertension: results from two surveys in low/middle-income countries. BMJ Open 2023; 13:e072192. [PMID: 37487684 PMCID: PMC10373743 DOI: 10.1136/bmjopen-2023-072192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES Team-based care is essential for improving hypertension outcomes in low-resource settings. We assessed perceptions of country representatives and healthcare workers (HCWs) on team-based hypertension care in low/middle-income countries. DESIGN Two cross-sectional surveys. SETTING The first survey (Country Profile Survey) was conducted in 17 countries and eight in-country regions: Algeria, Bangladesh, Burundi, Chile, China (Beijing, Henan, Shandong), Cuba, Ethiopia, India (Kerala, Madhya Pradesh, Maharashtra, Punjab, Telangana), Nepal, Nigeria, Philippines, Saint Lucia, Sri Lanka, Thailand, Turkey, Uganda and Vietnam. The second survey (HCW Survey) was conducted in four countries: Bangladesh, China, Ethiopia and Nigeria. PARTICIPANTS Using convenience sampling, participants for the Country Profile Survey were representatives from 17 countries and eight in-country regions, and the HCW Survey was administered to HCWs in Bangladesh, China, Ethiopia and Nigeria. OUTCOME MEASURES Country-level use of team-based hypertension care framework, comprising administrative, basic and advanced clinical tasks. Current practices of different HCW cadres, perspectives on team-based management of hypertension, barriers and facilitators. RESULTS In the Country Profile Survey, all (23/23, 100%) countries/regions surveyed integrated team-based care for basic clinical hypertension management tasks, less for advanced tasks (7/23, 30%). In the HCW Survey, 854 HCWs participated, 47% of whom worked in rural settings. Most HCWs in the sample acknowledged the value of team-based hypertension care. Although there were slight variations by country in the study sample, overall, barriers to team-based hypertension care were identified as inadequate training (83%); regulatory issues (76%); resistance by patients (56%), physicians (42%) and nurses (40%). Facilitators identified were use of treatment algorithms (94%), telehealth/m-health technology (92%) and adequate compensation for HCWs (80%). CONCLUSIONS Our findings revealed key lessons for health systems and governments regarding team-based care implementation. Specifically, policies to facilitate additional training, optimise HCWs' roles within care teams, use of hypertension treatment protocols and telehealth/m-health technology will be essential to promote team-based care.
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Affiliation(s)
| | | | - Andrew E Moran
- Resolve to Saves Lives, New York, New York, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kunihiro Matsushita
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Addisu Worku
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Shamim Jubayer
- National Heart Foundation of Bangladesh, Dhaka, Bangladesh
- Dental Public Health, University Dental College and Hospital, Dhaka, Bangladesh
| | | | - Shahinul Islam
- National Heart Foundation of Bangladesh, Dhaka, Bangladesh
| | - Kufor Osi
- Resolve to Saves Lives, New York, New York, USA
| | - Joseph Odu
- Resolve to Saves Lives, New York, New York, USA
| | | | - Dike Ojji
- Department of Internal Medicine, University of Abuja, Abuja, Nigeria
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mark D Huffman
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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de Souza Cazarim M, Cruz-Cazarim ELC, Boyd K, Wu O, Nunes AA. Effect of Medication Therapy Management by Pharmaceutical Care on Blood Pressure and Cardiovascular Risk in Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression. Pharmaceuticals (Basel) 2023; 16:845. [PMID: 37375792 DOI: 10.3390/ph16060845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Medication therapy management by pharmaceutical care (MTM-PC) has been shown to improve the effectiveness of antihypertensive treatments. The aim was to answer the question: what are the MTM-PC models and their impact on hypertensive patients' outcomes? This is a systematic review with meta-analysis. The search strategies were run on 27 September 2022 in the following databases: PubMed, EMBASE, Scopus, LILACs, Central Cochrane Library, Web of Science; and International Pharmaceutical Abstracts. The quality and bias risk was assessed by the Downs and Black instrument. Forty-one studies met the eligibility criteria and were included, Kappa = 0.86; 95% CI, 0.66-1.0; (p < 0.001). Twenty-seven studies (65.9%) had MTM-PC models outlined by the clinical team, showing as characteristics the mean of 10.0 ± 10.7 months of follow-up of hypertensive patients, with 7.7 ± 4.9 consultations. Instruments to assess the quality of life measured the enhancement by 13.4 ± 10.7% (p = 0.047). The findings of the meta-analysis show a mean reduction of -7.71 (95% CI, -10.93 to -4.48) and -3.66 (95% CI, -5.51 to -1.80), (p < 0.001) in mmHg systolic and diastolic pressures, respectively. Cardiovascular relative risk (RR) over ten years was 0.561 (95% CI, 0.422 to 0.742) and RR = 0.570 (95% CI, 0.431 to 0.750), considering homogeneous studies, I² = 0%. This study shows the prevalence of MTM-PC models outlined by the clinical team, in which there are differences according to the models in reducing blood pressure and cardiovascular risk over ten years with the improvement in quality of life.
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Affiliation(s)
- Maurilio de Souza Cazarim
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora 36036-900, MG, Brazil
| | - Estael Luzia Coelho Cruz-Cazarim
- Department of Pharmaceutical Service, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, SP, Brazil
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Altacílio Aparecido Nunes
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, SP, Brazil
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Klein A, Berger TC, Hapfelmeier A, Schaffert M, Matuja W, Schmutzhard E, Winkler AS. Does the presence of a specialist doctor reduce the burden of disease in people with epilepsy in low-resource settings? A comparison of two epilepsy clinics in rural Tanzania. Epilepsy Behav 2023; 139:109030. [PMID: 36577550 DOI: 10.1016/j.yebeh.2022.109030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND With an estimated lifetime prevalence of epilepsy of 7.6 per 1,000 people, epilepsy represents one of the most common neurological disorders worldwide, with the majority of people with epilepsy (PWE) living in low-income and middle-income countries (LMICs). Adequately treated, up to 70 % of PWE will become seizure-free, however, as many as 85% of PWE worldwide, mostly from LMICs, do not receive adequate treatment. OBJECTIVE To assess the impact of the presence of a neurologist on the management of PWE in Tanzania. METHODS Two epilepsy clinics in rural Tanzania, one continuously attended by a neurologist, and one mainly attended by nurses with training in epilepsy and supervised intermittently by specialist doctors (neurologists/psychiatrists) were comparatively analyzed by multivariable linear and logistic regression models with regard to the outcome parameters seizure frequency, the occurrence of side effects of antiepileptic medication and days lost after a seizure. RESULTS The presence of a neurologist significantly reduced the mean number of seizures patients experienced per month by 4.49 seizures (p < 0.01) while leading to an increase in the occurrence of reported side effects (OR: 2.15, p = 0.02). CONCLUSION The presence of a neurologist may play a substantial role in reducing the burden of the disease of PWE in LMICs. Hence, specialist training should be encouraged, and relevant context-specific infrastructure established.
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Affiliation(s)
- Ana Klein
- Center for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany.
| | - Toni Christoph Berger
- Center for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Germany; Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Germany.
| | - Matthias Schaffert
- Paracelsus Medical University, Department for Paediatric and Adolescent Surgery, Salzburg, Austria.
| | - William Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | | | - Andrea S Winkler
- Center for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany; Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
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Parati G, Goncalves A, Soergel D, Bruno RM, Caiani EG, Gerdts E, Mahfoud F, Mantovani L, McManus RJ, Santalucia P, Kahan T. New perspectives for hypertension management: progress in methodological and technological developments. Eur J Prev Cardiol 2023; 30:48-60. [PMID: 36073370 DOI: 10.1093/eurjpc/zwac203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/21/2022] [Accepted: 09/05/2022] [Indexed: 01/14/2023]
Abstract
Hypertension is the most common and preventable risk factor for cardiovascular disease (CVD), accounting for 20% of deaths worldwide. However, 2/3 of people with hypertension are undiagnosed, untreated, or under treated. A multi-pronged approach is needed to improve hypertension management. Elevated blood pressure (BP) in childhood is a predictor of hypertension and CVD in adulthood; therefore, screening and education programmes should start early and continue throughout the lifespan. Home BP monitoring can be used to engage patients and improve BP control rates. Progress in imaging technology allows for the detection of preclinical disease, which may help identify patients who are at greatest risk of CV events. There is a need to optimize the use of current BP control strategies including lifestyle modifications, antihypertensive agents, and devices. Reducing the complexity of pharmacological therapy using single-pill combinations can improve patient adherence and BP control and may reduce physician inertia. Other strategies that can improve patient adherence include education and reassurance to address misconceptions, engaging patients in management decisions, and using digital tools. Strategies to improve physician therapeutic inertia, such as reminders, education, physician-peer visits, and task-sharing may improve BP control rates. Digital health technologies, such as telemonitoring, wearables, and other mobile health platforms, are becoming frequently adopted tools in hypertension management, particularly those that have undergone regulatory approval. Finally, to fight the consequences of hypertension on a global scale, healthcare system approaches to cardiovascular risk factor management are needed. Government policies should promote routine BP screening, salt-, sugar-, and alcohol reduction programmes, encourage physical activity, and target obesity control.
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Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | | | - David Soergel
- Cardiovascular, Renal, and Metabolic Drug Development, Novartis, Basel, CH 4056, Switzerland
| | - Rosa Maria Bruno
- Paris Cardiovascular Research Centre (PARCC-INSERM U970) & Université de Paris, Paris 75015, France
| | - Enrico Gianluca Caiani
- Politecnico di Milano, Electronics, Information and Bioengineering Department, Institute of Electronics, Computer and Telecommunication Engineering (IEIIT), National Research Council of Italy (CNR), Milan 20133 & 24-10129, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen NO-5020, Norway
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg 66123, Germany
| | - Lorenzo Mantovani
- Value-based Healthcare Unit, IRCCS MultiMedica Research Hospital, University of Milan, Milan, Italy
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6HD, UK
| | - Paola Santalucia
- Italian Association Against Thrombosis and Cardiovascular Diseases (ALT Onlus), Milan 20123, Italy
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm SE 182 88, Sweden.,Department of Cardiology, Danderyd University Hospital Corp, Stockholm SE 182 88, Sweden
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Kavita K, Thakur J, Ghai S, Narang T, Kaur R. Nurse-led interventions for prevention and control of noncommunicable diseases in low- and middle-income countries: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2023. [DOI: 10.4103/jncd.jncd_74_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Pang L, Kottu L, Guo Z, Shi Y, Ferdous M, Zhao Y, Tang M, Liu W, Fang J, Fu H, Wu X, Ma M, Wang H, Merkus D, Duo L. Dawning public health services dogma: An indigenous Southwest Chinese perspective in managing hypertension-with or without the "BPHS"? Front Public Health 2022; 10:1017795. [PMID: 36438225 PMCID: PMC9686286 DOI: 10.3389/fpubh.2022.1017795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background To alleviate the rising mortality burden due to hypertension and other non-communicable diseases, a new public health policy initiative in 2009 called the Basic Public Health Services (BPHS). Program was introduced by the Chinese government. The goal of the study is to assess the feasibility and impact of a nationwide health care service-the "BPHS". Methods From January to December 2021, a stratified multistage random sampling method in the survey was conducted to select 6,456 people from 8 cities/districts in Yunnan Province, China, who were above the age of 35 years. 1,521 hypertensive patients were previously aware of their high blood pressure status were matched to the BPHS program database based on ID number and then further divided into BPHS group and non-BPHS (control) group. The results of the current study are based on their responses to a short structured questionnaire, a physical examination, and laboratory tests. The association between BPHS management and its effect on the control of hypertension was estimated using multivariable logistic regression models. We evaluated the accessibility and efficacy of BPHS health care services by analyzing various variables such as blood pressure, BMI, lifestyle modification, anti-hypertensive drugs taken, and cardiovascular risk factors. Results Among the 1,521 hypertensive patients included in this study, 1,011 (66.5%) were managed by BPHS programme. The multivariable logistic regression model demonstrated that the BPHS facilitated hypertension control (OR = 1.640, 95% CI: 1.237-2.175). A higher proportion of participants receiving lifestyle guidance from the BPHS management showed lowering of total cholesterol. In comparison to the non-BPHS group, those under BPHS management adhered better to antihypertensive medications either single drug (54.3%) or in combination (17.3%) of drugs. Additionally, we also noticed that urban areas with centralized and well-established digital information management system had better hypertension treatment and control. Conclusions Nearly two-thirds of the hypertensive patients in Yunnan Province were included in BPHS management. The impact of the national BPHS program was evident in lowering risk factors for cardiovascular diseases, promoting healthy lifestyles, lowering blood pressure, increasing medication adherence, and the better control rate of hypertension.
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Affiliation(s)
- Linhong Pang
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China,School of Public Health, Kunming Medical University, Kunming, China
| | - Lakshme Kottu
- Division of Experimental Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Zihong Guo
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yi Shi
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Misbahul Ferdous
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yajing Zhao
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Mingjing Tang
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Wei Liu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Jiayu Fang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Hongchen Fu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Xia Wu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Min Ma
- School of Public Health, Kunming Medical University, Kunming, China
| | - Huadan Wang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Daphne Merkus
- Division of Experimental Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands,Walter Brendel Center of Experimental Medicine (WBex), LMU Munich, Munich, Germany
| | - Lin Duo
- Affiliated Cardiovascular Hospital of Kunming Medical University, Fuwai Yunnan Cardiovascular Hospital, Kunming, China,*Correspondence: Lin Duo
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