Implementing and Scaling Up a Team-based Care Strategy for Hypertension Control in Colombia and Jamaica

在哥伦比亚和牙买加实施和扩大基于团队的高血压控制护理策略

基本信息

批准号：
10514987
负责人：
Jiang He
金额：
$ 137.86万
依托单位：
UNIVERSITY OF THE WEST INDIES
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：
2020-09-15 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10514987
关键词：
Address Adoption Adult Affect Antihypertensive Agents Blood Pressure Cardiovascular Diseases Caribbean region Caring Cessation of life Clinic Clinical Clinical Trials Data Monitoring Committees Cluster randomized trial Colombia Communities Community Health Aides Control Groups Cost Effectiveness Analysis Data Development Effectiveness Elements Ensure Evaluation Evidence based intervention Federal Government Follow-Up Studies Funding General Population Geographic Locations Goals Government Agencies Grant Health Health system High Prevalence Home Blood Pressure Monitoring Hypertension Informed Consent Institutional Review Boards Intention Intervention Intervention Trial Interview Jamaica Knowledge Latin America Life Style Local Government Maintenance Manuals Mediation Needs Assessment Nurses Observational Study Outcome Study Patients Penetrance Pharmaceutical Preparations Pharmacists Phase Physicians Population Primary Health Care Procedures Protocols documentation Provider Public Health Randomized Reach Effectiveness Adoption Implementation and Maintenance Research Personnel Self Management Side Supervision Surveys System Testing Training United States National Institutes of Health Visit Work base blood pressure control burden of illness cardiovascular disorder risk cardiovascular risk factor cluster trial control trial cultural health disability effectiveness outcome follow-up group intervention hypertension control hypertensive implementation cost implementation fidelity implementation outcomes implementation research implementation strategy interest low and middle-income countries medication compliance multidisciplinary premature primary care setting recruit scale up treatment as usual

项目摘要

Project Summary/Abstract Hypertension disproportionally affects populations in low- and middle-income countries (LMICs), especially in Latin America and the Caribbean (LAC), with a high prevalence and low control rate, resulting in an excess burden of cardiovascular disease (CVD). Despite widely available evidence-based interventions, only 7.7% of patients in LMICs had their blood pressure (BP) controlled in 2010. To close the knowledge-practice gap for hypertension control in LAC, a multidisciplinary team of investigators from Colombia, Jamaica, and the US will work with national and local government agencies and health systems to test the implementation and effectiveness outcomes of implementing and scaling up a team-based care strategy for BP control in Colombia and Jamaica. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework is being used to guide the development and evaluation of the implementation strategies. Physician-nurse (or pharmacist)-community health worker (CHW) teams will work collaboratively with patients to achieve shared treatment goals. Nurses or pharmacists will titrate medications using a simple protocol under physician supervision, CHWs will conduct health coaching on lifestyle change and medication adherence, and patients will actively engage in self-management (including home BP monitoring). Specific Aim 1 will test the reach, effectiveness, adoption, implementation (fidelity), and maintenance (sustainability) of implementing a team- based care strategy in a cluster randomized trial. A total of 40 primary care clinics (20 from Colombia and 20 from Jamaica; 32 patients per clinic and 1,280 in total) will be randomly assigned to a team-based care strategy or enhanced usual care for 12 months to test implementation and effectiveness outcomes. A 6-month post-trial follow-up study will be conducted to assess sustainability. This trial has 90% statistical power to detect an absolute difference of 15% in hypertension control (BP<140/90 mm Hg) using a 2-sided significance level of 0.05. Specific Aim 2 will assess barriers and implementation outcomes of scaling up a team-based care strategy in an observational study. Training will be provided to scale up team-based care in all remaining 141 primary care clinics (78 from Colombia and 63 from Jamaica) after the cluster trial. However, scale-up activities will not be supported by external funding. Barriers and implementation outcomes will be collected using interview, survey, and administrative data at primary care clinic and provider team levels. In addition, we will be able to compare implementation outcomes among 3 groups — intervention with external funding (clinics in the trial intervention group), intervention without external funding (clinics in the observational study), and usual care (clinics in the trial control group). We will conduct mediation analyses to understand the mechanisms of team-based care on BP control and a cost-effectiveness analysis to estimate implementation costs. The proposed study will identify effective, equitable, and sustainable strategies to achieve hypertension control in routine clinical settings and reduce CVD risk in the general population of LAC and other LMICs.

项目摘要/摘要高血压不成比例地影响低收入和中等收入国家（LMIC）的人口，尤其是在拉丁美洲和加勒比海（LAC），患病率很高，控制率较低，导致超过心血管疾病的负担（CVD）。尽管有广泛可用的循证干预措施，但只有7.7％ LMIC的患者在2010年控制了血压（BP）。 LAC中的高血压控制，来自哥伦比亚，牙买加和美国的多学科调查员团队与国家和地方政府机构和卫生系统合作，以测试实施和在哥伦比亚实施和扩展基于团队的护理策略的有效性结果和牙买加。 Re-Aim（达到有效性采用实施维护）框架正在用于指导实施策略的发展和评估。医师nurse（或药剂师） - 社区卫生工作者（CHW）团队将与患者合作，以实现共享治疗目标。护士或药剂师将使用医师的简单方案滴定药物监督，CHW将在生活方式改变和药物遵守方面进行健康指导，并进行患者将积极参与自我管理（包括家庭BP监控）。特定目标1将测试覆盖范围，实施团队的有效性，采用，实施（忠诚）和维护（可持续性）在群集随机试验中基于护理策略。共有40个初级保健诊所（哥伦比亚20个，20个来自牙买加；每个诊所的32例患者总共将随机分配给基于团队的护理战略或增强了12个月的通常护理，以测试实施和有效性结果。一个6个月将进行后随访研究以评估可持续性。该试验具有90％的统计能力使用2面显着性检测高血压控制（BP <140/90 mm Hg）的绝对差异15％水平为0.05。特定目标2将评估扩大基于团队的障碍和实施成果一项考试研究中的护理策略。将提供培训以扩大所有剩余的基于团队的护理聚集试验后，141个初级保健诊所（来自哥伦比亚的78名来自哥伦比亚的78名来自牙买加的63个）。但是，扩展活动将不受外部资金的支持。将收集障碍和实施成果使用初级保健诊所和提供商团队级别的访谈，调查和行政数据。另外，我们将能够比较三个小组之间的实施成果 - 外部资金（诊所）的干预在试验干预组中），没有外部资金的干预措施（观察性研究中的诊所），通常的护理（试验对照组的诊所）。我们将进行调解分析，以了解基于团队的BP控制和成本效益分析以估算实施的机制费用。拟议的研究将确定有效，公平和可持续的策略以达到高血压控制常规临床环境并降低LAC和其他LMIC的普通人群中的CVD风险。