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：
10260388
负责人：
Jiang He
金额：
$ 59.36万
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 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10260388
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 regulation burden of illness cardiovascular disorder risk cardiovascular risk factor cluster trial control trial cultural health disability effectiveness outcome follow-up group intervention hypertension control 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.

项目概要/摘要高血压对低收入和中等收入国家 (LMIC) 的人口影响尤为严重，尤其是在拉丁美洲和加勒比地区（LAC）患病率高，控制率低，导致过量尽管有广泛的循证干预措施，但只有 7.7% 的人患有心血管疾病 (CVD)。 2010 年，中低收入国家的患者血压 (BP) 得到控制。来自哥伦比亚、牙买加和美国的多学科研究小组将致力于拉丁美洲和加勒比地区的高血压控制与国家和地方政府机构以及卫生系统合作，测试实施情况并在哥伦比亚实施和扩大基于团队的血压控制护理策略的有效性结果牙买加正在实施 RE-AIM（达到有效性采用实施维护）框架。用于指导实施策略的制定和评估。药剂师）-社区卫生工作者（CHW）团队将与患者合作，实现共享护士或药剂师将在医生的指导下使用简单的方案滴定药物。监督，社区卫生工作者将就生活方式改变和药物依从性进行健康指导，患者将积极进行自我管理（包括家庭血压监测）具体目标 1 将测试达到的程度，实施团队的有效性、采用性、实施（保真度）和维护（可持续性）一项整群随机试验中基于护理策略的研究共有 40 个初级保健诊所（20 个来自哥伦比亚，20 个来自哥伦比亚）。来自牙买加；每个诊所 32 名患者，总共 1,280 名）将被随机分配到基于团队的护理策略或强化常规护理 12 个月，以测试实施情况和有效性结果 A 6 个月。将进行试验后跟踪研究以评估可持续性，该试验具有 90% 的统计功效。使用双侧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。具体目标 2 将评估扩大基于团队的障碍和实施结果。将提供观察研究中的护理策略，以扩大所有剩余的基于团队的护理。集群试验后有 141 个初级保健诊所（78 个来自哥伦比亚，63 个来自牙买加）。活动不会受到外部资金的支持，并且将收集实施结果。此外，我们还使用初级保健诊所和提供者团队层面的访谈、调查和管理数据。将能够比较 3 组之间的结果实施情况——外部资金干预（诊所在试验干预组中），无外部资助的干预（观察性研究中的诊所），以及我们将进行中介分析以了解常规护理（试验对照组的诊所）。基于团队的血压控制护理机制以及评估实施情况的成本效益分析拟议的研究将确定有效、公平和可持续的策略来实现高血压。在常规临床环境中进行控制并降低拉丁美洲和加勒比地区和其他中低收入国家一般人群的 CVD 风险。