Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS)

加强整个卫生系统高血压管理的转诊网络（优势）

• 批准号: 10215277
• 负责人: CONSTANTINE AKWANALO
• 金额: $ 30.49万
• 依托单位: MOI UNIVERSITY COLLEGE OF HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10215277
• 关键词: Abnormal coordination; Address; Blood Pressure; Cardiovascular Diseases; Caring; Cause of Death; Characteristics; Chronic Disease; Clinical; Cluster randomized trial; Complex; Continuity of Patient Care; Data; Diagnostic; Disease Management; Dose; Effectiveness; Effectiveness of Interventions; Ensure; Evaluation; Health; Health Status; Health system; Hypertension; Individual; Intervention; Kenya; Knowledge; Mediating; Mediation; Methods; Modeling; Morbidity - disease rate; Outcome; Outcome Measure; Pathway Analysis; Patients; Principal Investigator; Process; Provider; Qualitative Methods; Quality of Care; Readiness; Research; Research Project Grants; Resources; Risk Reduction; System; Testing; Uncomplicated Hypertension; Vulnerable Populations; Work; acceptability and feasibility; adherence rate; arm; base; blood pressure regulation; cardiovascular disorder risk; cardiovascular risk factor; care coordination; contextual factors; cost; cost effective; cost-effectiveness evaluation; design; disability-adjusted life years; effectiveness evaluation; evidence base; feasibility testing; health care availability; health information technology; hypertension control; hypertension treatment; implementation measures; implementation research; improved; improved outcome; incremental cost-effectiveness; innovation; iterative design; knowledge base; low and middle-income countries; mortality; peer; peer support; prevent; primary outcome; recruit; secondary outcome; treatment as usual; treatment strategy; trial comparing

Abstract: Strengthening Referral Networks for Management of Hypertension Across the Health System Elevated blood pressure is the leading cause of global mortality and is increasingly prevalent in lower-middle- income countries (lower-MICs). Treatment and control of hypertension is an evidence-based and cost-effective strategy to reduce cardiovascular disease (CVD); however, rates of treatment and control of hypertension in lower-MICs are low. Strong referral networks for hypertension management are essential to ensure access to quality care as well as appropriate resource utilization. Patients with uncomplicated hypertension can be re- ferred to lower levels while patients with complicated hypertension requiring complex diagnostic and treatment strategies should be referred to higher levels. Referral adherence rates remain low, however, hindering effec- tive hypertension care. Contextual and culturally appropriate interventions are required to strengthen referral networks for hypertension control. Health information technology (HIT) and peer-based support strategies have shown potential in improving outcomes in communicable and non-communicable disease management. How- ever, their effectiveness in strengthening referral networks to improve hypertension control is relatively un- known. Therefore, the overall objective of this proposal is to utilize transdisciplinary implementation research, guided by the PRECEDE-PROCEED framework, to address the challenge of improving hypertension control in low-resource settings. We propose to test the hypothesis that referral networks strengthened by an integrated HIT and peer support intervention will be effective and cost-effective in improving hypertension control among patients in western Kenya. We further hypothesize that changes in referral network characteristics may medi- ate the impact of these interventions, and that baseline referral network characteristics may moderate the im- pact. Aim 1 is to conduct a needs and contextual assessment to evaluate factors that may impact integration of HIT and peer support in this setting, using a mixed-methods approach. We will then design a contextually and culturally appropriate intervention to strengthen referral networks for hypertension control. Aim 2 is to evaluate the effectiveness of the intervention among individuals with hypertension, by conducting a two-arm cluster ran- domized trial comparing usual care to an integrated HIT and peer support intervention to enhance referrals. The primary outcome measure will be one-year change in systolic blood pressure, and a key secondary out- come will be change in QRISK2 CVD risk score. We will also conduct a mediation analysis and a moderation analysis to evaluate the influence of referral network characteristics on outcomes. Aim 3 is to evaluate the cost-effectiveness of the intervention. The research will be accomplished by a transdisciplinary research team with diverse and complementary expertise, led by two Early Stage Principal Investigators. We aim to add to existing knowledge of innovative, scalable, and sustainable strategies to reduce CVD risk in hypertension and other chronic diseases among vulnerable populations in low-resource settings worldwide.

摘要：加强整个卫生系统高血压管理的转诊网络 血压升高是全球死亡的主要原因，并且在中低收入人群中越来越普遍。 收入国家（低收入国家）。高血压的治疗和控制是一种基于证据且具有成本效益的方法 减少心血管疾病（CVD）的策略；然而，高血压的治疗和控制率 较低的 MIC 较低。强大的高血压管理转诊网络对于确保获得服务至关重要 优质护理以及适当的资源利用。无并发症的高血压患者可以重新 当复杂性高血压患者需要复杂的诊断和治疗时，血压会降低到较低水平 战略应向上级汇报。然而，推荐依从率仍然很低，这阻碍了效果 积极的高血压护理。需要根据具体情况和文化采取适当的干预措施来加强转诊 高血压控制网络。卫生信息技术 (HIT) 和基于同伴的支持策略已 显示出改善传染性和非传染性疾病管理结果的潜力。如何- 迄今为止，它们在加强转诊网络以改善高血压控制方面的效果相对较差。 已知。因此，该提案的总体目标是利用跨学科实施研究， 以 PRECEDE-PROCEED 框架为指导，应对改善高血压控制的挑战 低资源设置。我们建议检验这样的假设：推荐网络通过综合的 HIT 和同伴支持干预对于改善高血压患者的控制将是有效且具有成本效益的 肯尼亚西部的患者。我们进一步假设推荐网络特征的变化可能会导致 吃了这些干预措施的影响，基线转诊网络特征可能会缓和这些干预措施的影响 协议。目标 1 是进行需求和背景评估，以评估可能影响整合的因素 在这种情况下，HIT 和同行支持采用混合方法。然后我们将根据上下文设计一个 文化上适当的干预措施，以加强高血压控制的转诊网络。目标 2 是评估 通过进行双臂集群随机试验来评估高血压患者干预的有效性 比较常规护理与综合 HIT 和同伴支持干预以加强转诊的局部试验。 主要结果指标将是收缩压的一年变化，以及关键的次要结果 QRISK2 CVD 风险评分将会发生变化。我们还将进行中介分析和调节 分析以评估推荐网络特征对结果的影响。目标 3 是评估 干预的成本效益。该研究将由跨学科研究团队完成 具有多元化和互补的专业知识，由两名早期首席研究员领导。我们的目标是添加到 降低高血压和心血管疾病风险的创新、可扩展和可持续策略的现有知识 全世界资源匮乏地区弱势群体中的其他慢性病。

项目成果

Community engagement to inform development of strategies to improve referral for hypertension: perspectives of patients, providers and local community members in western Kenya.

• DOI: 10.1186/s12913-023-09847-0
• 发表时间: 2023-08-11
• 期刊: BMC HEALTH SERVICES RESEARCH
• 影响因子: 2.8
• 作者: Naanyu, Violet;Njuguna, Benson;Koros, Hillary;Andesia, Josephine;Kamano, Jemima;Mercer, Tim;Bloomfield, Gerald;Pastakia, Sonak;Vedanthan, Rajesh;Akwanalo, Constantine
• 通讯作者: Akwanalo, Constantine