Optimizing Linkage and Retention to Hypertension Care in Rural Kenya

优化肯尼亚农村地区高血压护理的联系和保留

基本信息

批准号：
8466375
负责人：
Valentin Fuster
金额：
$ 50.72万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-05-04 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8466375
关键词：
Address Adult Affect Africa South of the Sahara African Age Agency for International Development Awareness Behavioral Blood Pressure Cardiovascular Diseases Caring Cause of Death Chronic Chronic Disease Clinic Clinical Clinical Services Communication Communities Community Health Country Development Economic Burden Effectiveness Electronic Health Record Elements Emotional Epidemiology Evidence based intervention Face Focus Groups Government Health Health Services Accessibility Home environment Hypertension Income Individual Intervention Investigation Kenya Knowledge Link Medical Records Modeling Outcome Measure Participant Patients Population Prevalence Qualitative Research Research Research Methodology Research Personnel Research Technics Resources Risk Factors Risk Reduction Rural Solutions System Techniques Technology Testing Time Training United States Work arm base cardiovascular disorder risk care delivery clinical care cost cost effective cost effectiveness design health belief health economics hypertension control implementation research improved innovation mortality multidisciplinary novel primary outcome programs randomized trial tool treatment as usual trial comparing usability

项目摘要

DESCRIPTION (provided by applicant): Optimizing Linkage and Retention to Hypertension Care in Rural Kenya. Cardiovascular disease (CVD) is the leading cause of death in sub-Saharan Africa among adults above age 30. The prevalence of hypertension, a major risk factor for CVD, is increasing over time in sub-Saharan Africa, exerting a significant epidemiologic and economic burden on the region. Without adequate control of hypertension, its health and economic burden will increase drastically in the decades ahead. Well established and evidence-based interventions to manage hypertension exist; however, treatment and control rates are low. A critical component of hypertension management is to facilitate sustained access of affected individuals to effective clinical services. In partnership with the Government of Kenya, the United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership (AMPATH) is expanding its clinical scope of work in rural western Kenya to include hypertension and other chronic diseases. However, linking and retaining individuals with elevated blood pressure to the clinical care program has been difficult. Thus, the overall objective of this application is to utilize a multi-disciplinary implementation research approach t address the challenge of linking and retaining hypertensive individuals to a hypertension management program. Specifically, we propose to test the hypothesis that community health workers (CHWs), equipped with a tailored behavioral communication strategy and a smartphone-based tool linked to an electronic health record, can increase linkage and retention of hypertensive individuals to a hypertension care program and thereby significantly reduce blood pressure among these patients. We further hypothesize that these interventions will be cost-effective. Aim 1 is to identify facilitators and barriers to linking and retaining individualswith high blood pressure to a hypertension care delivery program, using innovative and novel qualitative research techniques. We will use the information derived from this investigation to design a tailored behavioral communication strategy and a smartphone-based tool to be used by CHWs to optimize linkage and retention of hypertensive patients. Aim 2 is to evaluate the effectiveness of CHWs equipped with these interventions in improving linkage and reducing blood pressure among hypertensive patients, by conducting a three-arm cluster randomized trial comparing: 1) usual care (CHWs with standard training on recruitment of individuals); 2) CHWs with an additional tailored behavioral communication strategy; and 3) CHWs with a tailored behavioral communication strategy who are also equipped with smartphones linked to the electronic health record. Aim 3 is to evaluate the incremental cost-effectiveness of each intervention arm of the cluster randomized trial, presented both in terms of costs per unit decrease in blood pressure and costs per reductions in CVD risk. The research will be accomplished by a multidisciplinary team of investigators with diverse and complementary expertise. We aim to add to existing knowledge on scalable and sustainable strategies for optimizing control of hypertension and other chronic diseases in low- and middle-income countries. RELEVANCE: Optimizing Linkage and Retention to Hypertension Care in Rural Kenya. Hypertension is the leading global risk factor for mortality and the global cost of suboptimal blood pressure is estimated to be nearly $1 trillion over the next decade. This project therefore aims to address a singularly critical health and development issue for low- and middle-income countries. The results of this work will add to the emerging body of knowledge on scalable and sustainable strategies for effectively managing hypertension and related chronic diseases in low- and middle-income countries, as well as resource-poor settings in the USA and other high-income countries.

描述（由申请人提供）：优化肯尼亚农村地区高血压护理的联系和保留。心血管疾病（CVD）是撒哈拉以南非洲30岁以上的撒哈拉以南非洲死亡的主要原因。高血压的患病率是CVD的主要危险因素，随着时间的流逝，撒哈拉以南非洲的时间正在增加，在该地区施加了重大的流行病学和经济负担。如果没有足够的高血压控制，其健康和经济负担将在未来几十年中大大增加。存在良好的基于证据的管理高血压的干预措施；但是，治疗和控制率很低。高血压管理的一个关键组成部分是促进受影响的人持续进入有效的临床服务。与肯尼亚政府合作，美国国际发展学术署提供了获得医疗保健合作伙伴关系（AMPATH）的方式正在扩大其在肯尼亚西部农村的临床工作范围，包括高血压和其他慢性病。但是，将血压升高的人与临床护理计划联系起来很困难。因此，本应用程序的总体目标是利用多学科实施研究方法t解决将高血压个体与高血压管理计划联系起来的挑战。具体而言，我们建议测试以下假设：配备有量身定制的行为沟通策略以及与电子健康记录相关的智能手机沟通策略的社区卫生工作者（CHW），可以将高血压个体与高血压护理计划的联系并保留到高血压护理计划中，从而显着降低这些患者的血压。我们进一步假设这些干预措施将具有成本效益。目的1是使用创新和新颖的定性研究技术确定促进者和障碍，以将高血压与高血压护理递送计划联系起来。我们将使用此调查得出的信息来设计量身定制的行为交流策略，以及基于智能手机的工具，可供CHW使用，以优化高血压患者的联系和保留。 AIM 2是通过进行三臂群集随机试验比较（1）通常的护理（对个人招募的标准培训），评估配备了这些干预措施在改善连接和降低血压方面的CHW的有效性； 2）具有额外量身定制的行为交流策略的CHW； 3）具有量身定制的行为交流策略的CHW，他们还配备了与电子健康记录相关的智能手机。 AIM 3是评估集群随机试验每个干预部门的增量成本效益，这两者都以每单位成本降低血压的成本和CVD风险降低的成本表示。这项研究将由具有多样化和互补专业知识的研究人员组成的多学科团队来完成。我们的目的是增加有关可扩展和可持续策略的现有知识，以优化低收入和中等收入国家的高血压和其他慢性疾病的控制。相关性：优化肯尼亚农村地区高血压护理的联系和保留。高血压是死亡率的全球领先风险因素，在未来十年中，全球血压的全球成本估计接近1万亿美元。因此，该项目旨在解决低收入和中等收入国家的奇特关键健康和发展问题。这项工作的结果将增加有关可扩展和可持续策略的新兴知识，以有效管理低收入和中等收入国家的高血压和相关慢性疾病，以及美国和其他高收入国家的资源贫乏的环境。