Phone-based Interventions under Nurse Guidance after Stroke II (PINGS II)

中风后在护士指导下进行的电话干预 II (PINGS II)

基本信息

批准号：
10405058
负责人：
BRUCE OVBIAGELE
金额：
$ 56.95万
依托单位：
NORTHERN CALIFORNIA INSTITUTE/RES/EDU
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-15 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10405058
关键词：
Academy Accident and Emergency department Address Adherence Adoption Adult Africa South of the Sahara Age Algorithms American Antihypertensive Agents Area Belief Brain Diseases Car Phone Cardiovascular system Caring Cellular Phone Chronic Country Data Effectiveness Etiology Event Focus Groups Funding Ghana Goals Health Health Benefit Health Personnel Health Services Accessibility Health Technology Health care facility Health education Healthcare Home Blood Pressure Monitoring Hospitals Hybrids Hypertension Improve Access Incidence Income Instruction Intake Intention Intervention Investments Learning Measures Mediator of activation protein Medical center Medicine Modification Monitor Nurses Outcome Outcome Measure Patients Pharmaceutical Preparations Physicians Pilot Projects Policies Population Prevalence Prevention strategy Quality of life Randomized Controlled Trials Recurrence Research Research Design Resource-limited setting Resources Risk Factors Self Efficacy Self Management Standardization Stroke System Techniques Telephone Testing Text Messaging Theoretical model Therapeutic Time United States United States National Institutes of Health Ursidae Family Work adverse outcome base blood pressure control blood pressure intervention blood pressure medication burden of illness cardiovascular emergency cardiovascular risk factor care outcomes clinical practice effectiveness evaluation efficacy testing evidence base experience global health high risk hospital readmission hypertension control hypertensive hypertensives implementation barriers implementation context implementation facilitators implementation strategy improved indexing low and middle-income countries mHealth medication compliance modifiable risk mortality post stroke preference primary outcome programs satisfaction secondary outcome stroke incidence stroke patient stroke risk stroke survivor systematic review treatment as usual underserved area unhealthy lifestyle usability usual care arm vascular risk factor

项目摘要

PROJECT SUMMARY Global estimates suggest that sub-Saharan Africa (SSA) now has the highest incidence and prevalence of stroke. However, limited system resources, meager patient resources, uncoordinated care, and shortage of clinicians, greatly hamper the capacity of countries in SSA to implement effective measures aimed at controlling key vascular risk factors such as hypertension (HTN) to thwart stroke recurrence in routine clinical practice. In particular, SSA has the highest estimated effect size of HTN for stroke causation worldwide. HTN is often unrecognized, undertreated and uncontrolled in a significant proportion of the adult population in this region due to a clustering of factors including cultural beliefs and misconceptions about hypertension, low self-efficacy, non- adherence to treatment, unavailability of health facilities, health personnel, lack of access to of antihypertensive medications, therapeutic inertia by physicians, and other factors. With the anticipated continued transition from primarily infectious conditions to chronic non-communicable diseases, the burden of stroke in SSA is likely to increase even further over the next several decades. Given all of the aforementioned factors, it is an urgent priority for countries in SSA to develop and test self-management interventions to control hypertension among those at highest risk of adverse outcomes. The overall objective of Phone-based Intervention under Nurse Guidance after Stroke II (PINGS-2) is to deploy a hybrid study design to firstly, demonstrate the efficacy in a randomized controlled trial of a theoretical-model-based, mHealth technology-centered, nurse-led, multi-level integrated approach to substantially improve longer term BP control among 500 recent stroke patients encountered at 10 hospitals in Ghana. Secondly, PINGS II seeks to develop an implementation strategy for routine integration and policy adoption of mhealth for post-stroke BP control in a LMIC setting. We will leverage experience gained from the NIH Global Brain Disorders funded R21 pilot study (NS094033) to test efficacy of a refined, culturally-tailored, and potentially implementable intervention aimed at addressing the premier modifiable risk for stroke & other key variables in an under-resourced system burdened by suboptimal care & outcomes. The primary outcome is blood pressure control at month 12 alongside a host of secondary outcome measures such as medication adherence, self-efficacy, cardiovascular emergency department encounters, quality of life, and mediator outcomes. While it is important to establish the efficacy of a nurse-led, m-health-centered self- management intervention for blood pressure control in LMICs, it equally crucial to simultaneously begin crafting an implementation plan. Hence we will seek to identify context-specific implementation facilitators and barriers, to understand the implementation context, and craft evidence-based implementation strategies for routine use & policy adoption of the PINGS intervention in Ghana through multiple stakeholder engagements.

项目概要全球估计表明，撒哈拉以南非洲 (SSA) 目前中风的发病率和患病率最高。然而，系统资源有限、患者资源贫乏、护理不协调、临床医生短缺，极大地阻碍了撒哈拉以南非洲国家实施旨在控制关键关键因素的有效措施的能力在常规临床实践中，高血压（HTN）等血管危险因素可阻止中风复发。在特别是，SSA 估计 HTN 对全球中风病因的影响大小最高。 HTN 经常是由于以下原因，该地区很大一部分成年人口未被认识、治疗不足和不受控制一系列因素包括对高血压的文化信仰和误解、自我效能感低、非坚持治疗、缺乏卫生设施、卫生人员、缺乏抗高血压药物药物、医生的治疗惰性和其他因素。随着预期的持续过渡从主要传染性疾病到慢性非传染性疾病，SSA 中风的负担可能会在接下来的几十年里还会进一步增加。考虑到上述所有因素，当务之急是撒哈拉以南非洲国家优先制定和测试自我管理干预措施，以控制高血压那些出现不良后果的风险最高的人。护士电话干预的总体目标中风后指导 II (PINGS-2) 是部署混合研究设计，首先证明其有效性基于理论模型、以移动医疗技术为中心、护士主导、多层次的随机对照试验综合方法可显着改善 500 名近期中风患者的长期血压控制在加纳的 10 家医院遇到过。其次，PINGS II 旨在制定一项实施战略中低收入国家中中风后血压控制的移动医疗的常规整合和政策采用。我们将利用从 NIH 全球脑疾病资助的 R21 试点研究 (NS094033) 中获得的经验，以测试精致的、根据文化定制的、并且有可能实施的干预措施，旨在解决首要的可修改问题资源贫乏的系统中的中风风险和其他关键变量，其护理和结果不佳。这主要结局是第 12 个月时的血压控制以及一系列次要结局指标，例如药物依从性、自我效能、心血管急诊科就诊情况、生活质量以及调解结果。虽然建立以护士为主导、以移动健康为中心的自我管理的有效性很重要，但中低收入国家血压控制的管理干预措施，同样重要的是同时开始制定实施计划。因此，我们将寻求确定具体情况的实施促进因素和障碍，以了解实施背景，并制定日常使用的基于证据的实施策略通过多个利益相关者的参与，加纳采取了 PINGS 干预政策。