Adapting the WHO Cardiovascular Disease Risk Management Package to the Ghanaian Community-Based Health Planning and Services (CHPS) Primary Care Model: An Implementation Pilot Study

将世卫组织心血管疾病风险管理一揽子计划适应加纳社区卫生规划和服务（CHPS）初级保健模式：一项实施试点研究

• 批准号: 9356360
• 负责人: James Franklin Phillips
• 金额: $ 17.5万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9356360
• 关键词: Address; Adult; Africa; Africa South of the Sahara; Autopsy; Awareness; Cardiovascular Diseases; Caring; Cause of Death; Cessation of life; Child Mortality; Clinic; Clinical; Communities; Community Health; Community Health Aides; Community Health Services; Country; Data; Databases; Developing Countries; Diagnosis; Disease; Economic Development; Education; Elements; Epidemiologic Monitoring; Fertility; Focus Groups; Future; Ghana; Group Structure; Guidelines; Health; Health Planning; Health Services; Health system; Hypertension; Incidence; Intervention; Interview; Knowledge; Laboratories; Lead; Learning; Measures; Methods; Modeling; Modification; Outpatients; Patient Education; Patients; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Plant Roots; Population; Prevalence; Prevention; Prevention program; Primary Health Care; Process; Protocols documentation; Provider; Regimen; Research; Research Infrastructure; Resources; Risk Factors; Risk Management; Standardization; Structure; Testing; Training; Work; World Health Organization; base; burden of illness; cardiovascular disorder prevention; cardiovascular disorder risk; disorder control; epidemiologic data; health belief; high risk; hypertension control; implementation science; improved; indexing; mortality; outreach; programs; screening; skills; treatment program; trend; volunteer

Project Summary and Abstract The burden of disease in sub-Saharan Africa is shifting rapidly towards non-communicable disease (NCD), of which cardiovascular disease (CVD) is the leading cause and hypertension the leading risk factor. A validated package of interventions for hypertension control and cardiovascular disease prevention exists, and has been piloted in select regions of Africa. However, the potential impact of this program on disease burden across populations remains unclear, because the sustainability of its implementation within established health systems remains unknown. We therefore propose to develop a pilot hypertension and CVD prevention program, based on the cardiovascular disease elements of the World Health Organization's Package for Essential Noncommunicable Disease (PEN-NCD) protocol [1,2], to successfully screen, diagnose, and control hypertension and other CVD risk factors as an element of the Community-Based Health Planning and Service (CHPS) program in Northern Ghana. We will develop and refine this approach based on the health beliefs of local communities, and the locally available health system building blocks, such as community health workers, outreach volunteers, and basic medication kits. Our research plan involves three phases. First, we will use multiple-decrement quantitative analyses, chart review and audits, structured provider observations, and provider written exams, to evaluate the capacity of CHPS' existing hypertension surveillance, screening, referral, and treatment programs. Second, we will use focus groups and structured interviews to identify gaps in this infrastructure and barriers to care. We will aim to identify barriers to hypertension care across health system building blocks. Third, we will use focus groups and structured interviews to identify solutions to identified barriers, which we will evaluate via structured observation of pilot test programs This analysis will aim to generate a complete pilot intervention to address hypertension and cardiovascular disease, based on WHO guidelines but adapted (in terms of use of health worker training; medication use; patient tracking; and all aspects of the health system) to the Navrongo context as delineated in the first two phases above. Our work will improve capacity for NCD care in sub-Saharan Africa in three ways. First, it will permit more accurate disease surveillance in a context in which even the extent of disease burden (let alone its root causes and means for control) remains a matter of debate. Second, it will generate a pilot regimen to determine whether a CHW-led primary care package can effectively help control the large and growing tide of preventable CVD in Ghana, a process that could lead to its implementation across the country. Thirdly, it will suggest the processes by which NCD programs such as WHO-PEN require modification across health systems, and hence how this program could be implemented nationwide across other contexts in Africa and developing countries.

项目概要和摘要 撒哈拉以南非洲地区的疾病负担正在迅速转向非传染性疾病 (NCD)，其中 其中心血管疾病（CVD）是主要原因，高血压是主要危险因素。经过验证的 存在高血压控制和心血管疾病预防的一揽子干预措施，并且已 在非洲部分地区进行试点。然而，该计划对整个国家疾病负担的潜在影响 人口仍不清楚，因为其在既定卫生系统内实施的可持续性 仍然未知。 因此，我们建议在以下基础上制定高血压和心血管疾病预防试点计划： 世界卫生组织基本非传染性疾病一揽子计划中的心血管疾病要素 疾病 (PEN-NCD) 方案 [1,2]，成功筛查、诊断和控制高血压和其他疾病 CVD 风险因素作为社区健康规划和服务 (CHPS) 计划的一个组成部分 加纳北部。我们将根据当地社区的健康信念制定和完善这一方法， 以及当地可用的卫生系统组成部分，例如社区卫生工作者、外展服务 志愿者和基本药物包。 我们的研究计划分为三个阶段。首先，我们将使用多重递减定量分析，图表 审查和审计、结构化的提供者观察和提供者书面考试，以评估提供者的能力 CHPS 现有的高血压监测、筛查、转诊和治疗计划。 其次，我们将利用焦点小组和结构化访谈来找出该基础设施中的差距和障碍 关心。我们的目标是确定卫生系统各个组成部分中高血压护理的障碍。 第三，我们将利用焦点小组和结构化访谈来确定针对已识别障碍的解决方案，我们将 将通过对试点测试计划的结构化观察进行评估 该分析旨在制定完整的试点干预措施，以解决高血压和心血管问题 疾病，基于世卫组织指南，但进行了调整（在使用卫生工作者培训；药物使用； 患者追踪；以及卫生系统的所有方面）到前两个所述的纳龙戈环境 上述阶段。 我们的工作将从三个方面提高撒哈拉以南非洲地区的非传染性疾病护理能力。首先，它将允许更多 在甚至疾病负担的程度（更不用说其根本原因）的背景下进行准确的疾病监测 和控制手段）仍然是一个有争议的问题。其次，它将制定一个试点方案来确定 由社区卫生工作者主导的初级保健方案能否有效帮助控制大规模且不断增长的可预防疾病浪潮 加纳的 CVD 流程可能会在全国范围内实施。第三，它将建议 WHO-PEN 等非传染性疾病规划需要整个卫生系统进行修改，因此 如何在非洲和发展中国家的其他情况下在全国范围内实施该计划。

项目成果

Community perspectives on cardiovascular disease control in rural Ghana: A qualitative study.

• DOI: 10.1371/journal.pone.0280358
• 发表时间: 2023
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Patil, Bhavana P.;Maddox, Isla Hutchinson;Aborigo, Raymond R.;Squires, Allison R.;Awuni, Denis F.;Horowitz, Carol R.;Oduro, Abraham J.;Phillips, James;Jones, Khadija;Heller, David
• 通讯作者: Heller, David

Impacting Global Health Delivery Through Advocacy: The Case of Losartan.

通过宣传影响全球卫生服务：洛沙坦案例。

• DOI: 10.1016/j.gheart.2018.11.001
• 发表时间: 2019
• 期刊: Global heart
• 影响因子: 3.7
• 作者: Heller,DavidJ;Kishore,SandeepP
• 通讯作者: Kishore,SandeepP

Closing the blood pressure gap: an affordable proposal to save lives worldwide.

• DOI: 10.1136/bmjgh-2017-000429
• 发表时间: 2017-01-01
• 期刊: BMJ global health
• 影响因子: 8.1
• 作者: Heller, David J;Kishore, Sandeep P
• 通讯作者: Kishore, Sandeep P

Constructing a Nurse-led Cardiovascular Disease Intervention in Rural Ghana: A Qualitative Analysis.

• DOI: 10.5334/aogh.3379
• 发表时间: 2021
• 期刊: Annals of global health
• 影响因子: 2.9
• 作者: Wood EP;Garvey KL;Aborigo R;Dambayi E;Awuni D;Squires AP;Jackson EF;Phillips JF;Oduro AR;Heller DJ
• 通讯作者: Heller DJ