Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis

T N Anand, Linju Maria Joseph, A V Geetha, Dorairaj Prabhakaran, Panniyammakal Jeemon, T N Anand, Linju Maria Joseph, A V Geetha, Dorairaj Prabhakaran, Panniyammakal Jeemon

Abstract

Background: Task sharing for the management of hypertension could be useful for understaffed and resource-poor health systems. We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries.

Methods: We searched the Cochrane Library, PubMed, Embase, and CINAHL for studies published up to December 2018. We included intervention studies involving a task-sharing strategy for management of blood pressure and other cardiovascular risk factors. We extracted data on population, interventions, blood pressure, and task sharing groups. We did a meta-analysis of randomised controlled trials.

Findings: We found 3012 references, of which 54 met the inclusion criteria initially. Another nine studies were included following an updated search. There were 43 trials and 20 before-and-after studies. We included 31 studies in our meta-analysis. Systolic blood pressure was decreased through task sharing in different groups of health-care workers: the mean difference was -5·34 mm Hg (95% CI -9·00 to -1·67, I2=84%) for task sharing with nurses, -8·12 mm Hg (-10·23 to -6·01, I2=57%) for pharmacists, -4·67 mm Hg (-7·09 to -2·24, I2=0%) for dietitians, -3·67 mm Hg (-4·58 to -2·77, I2=24%) for community health workers, and -4·85 mm Hg (-6·12 to -3·57, I2=76%) overall. We found a similar reduction in diastolic blood pressure (overall mean difference -2·92 mm Hg, -3·75 to -2·09, I2=80%). The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure, but low for diastolic blood pressure.

Interpretation: Task-sharing interventions are effective in reducing blood pressure. Long-term studies are needed to understand their potential impact on cardiovascular outcomes and mortality.

Funding: Wellcome Trust/DBT India Alliance.

Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Literature search and article inclusion SMS=short messaging service. CHW=community health worker. CKD=chronic kidney disease. LMIC=low-income and middle-income country. CVD=cardiovascular disease. SBP=systolic blood pressure. DBP=diastolic blood pressure. RCT=randomised controlled trial.
Figure 2
Figure 2
Systolic blood pressure changes with task sharing compared with usual care
Figure 3
Figure 3
Diastolic blood pressure changes with task sharing compared with usual care

References

    1. Roth GA, Johnson C, Abajobir A. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70:1–25.
    2. Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017; 70: 1–25.
    1. Hay SI, Abajobir AA, Abate KH. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1260–1344.
    2. Hay SI, Abajobir AA, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1260–344.
    1. Mancia G, Fagard R, Narkiewicz K. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertens. 2013;31:1281–1357.
    2. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281–357.
    1. Irazola VE, Gutierrez L, Bloomfield G. Hypertension prevalence, awareness, treatment, and control in selected LMIC communities: results from the NHLBI/UHG network of centers of excellence for chronic diseases. Global Heart. 2016;11:47–59.
    2. Irazola VE, Gutierrez L, Bloomfield G, et al. Hypertension prevalence, awareness, treatment, and control in selected LMIC communities: results from the NHLBI/UHG network of centers of excellence for chronic diseases. Global Heart 2016; 11: 47–59.
    1. Naghavi M, Abajobir AA, Abbafati C. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1151–1210.
    2. Naghavi M, Abajobir AA, Abbafati C, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1151–210.
    1. Sibbald B, Shen J, McBride A. Changing the skill-mix of the health care workforce. J Health Serv Res Policy. 2004;9(suppl):28–38.
    2. Sibbald B, Shen J, McBride A. Changing the skill-mix of the health care workforce. J Health Serv Res Policy 2004; 9 (suppl): 28–38.
    1. WHO. PEPFAR. UNAIDS . World Health Organization; Geneva: 2007. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines.
    2. WHO, PEPFAR, UNAIDS. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva: World Health Organization, 2007.
    1. Dawson AJ, Buchan J, Duffield C, Homer CSE, Wijewardena K. Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence. Health Policy Plan. 2014;29:396–408.
    2. Dawson AJ, Buchan J, Duffield C, Homer CSE, Wijewardena K. Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence. Health Policy Plan 2014; 29: 396–408.
    1. Joshi R, Thrift AG, Smith C. Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases. BMJ Glob Health. 2018;3(suppl 3):e001092.
    2. Joshi R, Thrift AG, Smith C, et al. Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases. BMJ Glob Health 2018; 3 (suppl 3): e001092.
    1. Bergström S. Training non-physician mid-level providers of care (associate clinicians) to perform caesarean sections in low-income countries. Best Pract Res Clin Obstet Gynaecol. 2015;29:1092–1101.
    2. Bergström S. Training non-physician mid-level providers of care (associate clinicians) to perform caesarean sections in low-income countries. Best Pract Res Clin Obstet Gynaecol 2015; 29: 1092–101.
    1. Lewin S, Munabi-Babigumira S, Glenton C. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;3 CD004015.
    2. Lewin S, Munabi-Babigumira S, Glenton C, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev 2010; 3: CD004015.
    1. Callaghan M, Ford N, Schneider H. A systematic review of task-shifting for HIV treatment and care in Africa. Hum Resour Health. 2010;8:8.
    2. Callaghan M, Ford N, Schneider H. A systematic review of task-shifting for HIV treatment and care in Africa. Hum Resour Health 2010; 8: 8.
    1. Ogedegbe G, Plange-Rhule J, Gyamfi J. A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol. Implement Sci. 2014;9:73.
    2. Ogedegbe G, Plange-Rhule J, Gyamfi J, et al. A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol. Implement Sci 2014; 9: 73.
    1. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010;3 CD005182.
    2. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev 2010; 3: CD005182.
    1. Anand TN, Joseph LM, Geetha AV, Chowdhury J, Prabhakaran D, Jeemon P. Task-sharing interventions for cardiovascular risk reduction and lipid outcomes in low- and middle-income countries: a systematic review and meta-analysis. J Clin Lipidol. 2018;12:626–642.
    2. Anand TN, Joseph LM, Geetha AV, Chowdhury J, Prabhakaran D, Jeemon P. Task-sharing interventions for cardiovascular risk reduction and lipid outcomes in low- and middle-income countries: a systematic review and meta-analysis. J Clin Lipidol 2018; 12: 626–42.
    1. Higgins JPT, Altman DG, Gøtzsche PC. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
    2. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.
    1. NHLBI . National Heart, Lung, and Blood Institute; Bethesda, MD, USA: 2014. Quality assessment tool for before-after (pre-post) studies with no control group.
    2. NHLBI. Quality assessment tool for before-after (pre-post) studies with no control group. National Heart, Lung, and Blood Institute: Bethesda, MD, USA; 2014.
    1. Rao JNK, Scott AJ. A simple method for the analysis of clustered binary data. Biometrics. 1992;48:577–585.
    2. Rao JNK, Scott AJ. A simple method for the analysis of clustered binary data. Biometrics 1992; 48: 577–85.
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–1558.
    2. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539–58.
    1. Riley RD, Higgins JPT, Deeks JJ. Interpretation of random effects meta-analyses. BMJ. 2011;342:d549.
    2. Riley RD, Higgins JPT, Deeks JJ. Interpretation of random effects meta-analyses. BMJ 2011; 342: d549.
    1. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629.
    2. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629.
    1. R Core Team R: a language and environment for statistical computing. 2018.
    2. R Core Team. R: a language and environment for statistical computing. 2018. (accessed March 10, 2019).
    1. Guyatt G, Oxman AD, Akl EA. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64:383–394.
    2. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64: 383–94.
    1. Garcia-Pena C, Thorogood M, Wonderling D, Reyes-Frausto S. Economic analysis of a pragmatic randomised trial of home visits by a nurse to elderly people with hypertension in Mexico. Salud Publica Mex. 2002;44:14–20.
    2. Garcia-Pena C, Thorogood M, Wonderling D, Reyes-Frausto S. Economic analysis of a pragmatic randomised trial of home visits by a nurse to elderly people with hypertension in Mexico. Salud Publica Mex 2002; 44: 14–20.
    1. Goldhaber-Fiebert JD, Goldhaber-Fiebert SN, Tristán ML, Nathan DM. Randomized controlled community-based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. Diabetes Care. 2003;26:24.
    2. Goldhaber-Fiebert JD, Goldhaber-Fiebert SN, Tristán ML, Nathan DM. Randomized controlled community-based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. Diabetes Care 2003; 26: 24.
    1. Jiang X, Sit JW, Wong TKS. A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. J Clin Nurs. 2007;16:1886–1897.
    2. Jiang X, Sit JW, Wong TKS. A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. J Clin Nurs 2007; 16: 1886–97.
    1. Sartorelli DS, Sciarra EC, Franco LJ, Cardoso MA. Beneficial effects of short-term nutritional counselling at the primary health-care level among Brazilian adults. Public Health Nutr. 2007;8:820–825.
    2. Sartorelli DS, Sciarra EC, Franco LJ, Cardoso MA. Beneficial effects of short-term nutritional counselling at the primary health-care level among Brazilian adults. Public Health Nutr 2007; 8: 820–25.
    1. Sookaneknun P, Richards RME, Sanguansermsri J, Teerasut C. Pharmacist involvement in primary care improves hypertensive patient clinical outcomes. Ann Pharmacother. 2004;38:2023–2028.
    2. Sookaneknun P, Richards RME, Sanguansermsri J, Teerasut C. Pharmacist involvement in primary care improves hypertensive patient clinical outcomes. Ann Pharmacother 2004; 38: 2023–28.
    1. Cakir H, Pinar R. Randomized controlled trial on lifestyle modification in hypertensive patients. West J Nurs Res. 2006;28:190–209.
    2. Cakir H, Pinar R. Randomized controlled trial on lifestyle modification in hypertensive patients. West J Nurs Res 2006; 28: 190–209.
    1. Hammad EA, Yasein N, Tahaineh L, Albsoul-Younes AM. A randomized controlled trial to assess pharmacist-physician collaborative practice in the management of metabolic syndrome in a university medical clinic in Jordan. J Manag Care Spec Pharm. 2011;17:295–303.
    2. Hammad EA, Yasein N, Tahaineh L, Albsoul-Younes AM. A randomized controlled trial to assess pharmacist-physician collaborative practice in the management of metabolic syndrome in a university medical clinic in Jordan. J Manag Care Spec Pharm 2011; 17: 295–303.
    1. Plaster C, Melo D, Boldt V. Reduction of cardiovascular risk in patients with metabolic syndrome in a community health center after a pharmaceutical care program of pharmacotherapy follow-up. Brazilian Journal of Pharmaceutical Sciences. 2012;48:435–446.
    2. Plaster C, Melo D, Boldt V, et al. Reduction of cardiovascular risk in patients with metabolic syndrome in a community health center after a pharmaceutical care program of pharmacotherapy follow-up. Brazilian Journal of Pharmaceutical Sciences 2012; 48: 435–46.
    1. Selvaraj FJ, Mohamed M, Omar K. The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial. BMC Fam Pract. 2012;13:97.
    2. Selvaraj FJ, Mohamed M, Omar K, et al. The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial. BMC Fam Pract 2012; 13: 97.
    1. Chao J, Wang Y, Xu H. The effect of community-based health management on the health of the elderly: a randomized controlled trial from China. BMC Health Serv Res. 2012;12:449.
    2. Chao J, Wang Y, Xu H, et al. The effect of community-based health management on the health of the elderly: a randomized controlled trial from China. BMC Health Serv Res 2012; 12: 449.
    1. Wal P, Wal A, Bhandari A, Pandey U, Rai A. Pharmacist involvement in the patient care improves outcome in hypertension patients. J Res Pharm Pract. 2013;2:123–129.
    2. Wal P, Wal A, Bhandari A, Pandey U, Rai A. Pharmacist involvement in the patient care improves outcome in hypertension patients. J Res Pharm Pract 2013; 2: 123–29.
    1. Saffi MAL, Polanczyk CA, Rabelo-Silva ER. Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: a randomized clinical trial. Eur J Cardiovasc Nurs. 2013;13:436–443.
    2. Saffi MAL, Polanczyk CA, Rabelo-Silva ER. Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: a randomized clinical trial. Eur J Cardiovasc Nurs 2013; 13: 436–43.
    1. Labhardt ND, Balo J-R, Ndam M, Manga E, Stoll B. Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: a cluster-randomised trial. Trop Med Int Health. 2011;16:1276–1284.
    2. Labhardt ND, Balo J-R, Ndam M, Manga E, Stoll B. Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: a cluster-randomised trial. Trop Med Int Health 2011; 16: 1276–84.
    1. Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. J Manag Care Spec Pharm. 2012;18:516–526.
    2. Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. J Manag Care Spec Pharm 2012; 18: 516–26.
    1. DePue JD, Rosen RK, Seiden A. Implementation of a culturally tailored diabetes intervention with community health workers in American Samoa. Diabetes Educ. 2013;39:761–771.
    2. DePue JD, Rosen RK, Seiden A, et al. Implementation of a culturally tailored diabetes intervention with community health workers in American Samoa. Diabetes Educ 2013; 39: 761–71.
    1. Zhao PX, Wang C, Qin L. Effect of clinical pharmacist's pharmaceutical care intervention to control hypertensive outpatients in China. Afr J Pharm Pharmacol. 2012;6:48–56.
    2. Zhao PX Wang C, Qin L, et al. Effect of clinical pharmacist's pharmaceutical care intervention to control hypertensive outpatients in China. Afr J Pharm Pharmacol 2012; 6: 48–56.
    1. Muchiri JW, Gericke GJ, Rheeder P. Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial. Public Health Nutr. 2016;19:142–155.
    2. Muchiri JW, Gericke GJ, Rheeder P. Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial. Public Health Nutr 2016; 19: 142–55.
    1. Hacihasanoğlu R, Gözüm S. The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours and BMI in a primary health care setting. J Clin Nurs. 2011;20:692–705.
    2. Hacihasanoğlu R, Gözüm S. The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours and BMI in a primary health care setting. J Clin Nurs 2011; 20: 692–705.
    1. Ma C, Zhou Y, Zhou W, Huang C. Evaluation of the effect of motivational interviewing counselling on hypertension care. Patient Educ Couns. 2014;95:231–237.
    2. Ma C, Zhou Y, Zhou W, Huang C. Evaluation of the effect of motivational interviewing counselling on hypertension care. Patient Educ Couns 2014; 95: 231–37.
    1. Zhu X, Wong FKY, Wu LH. Development and evaluation of a nurse-led hypertension management model in a community: a pilot randomized controlled trial. Int J Clin Exp Med. 2014;7:4369–4377.
    2. Zhu X, Wong FKY, Wu LH. Development and evaluation of a nurse-led hypertension management model in a community: a pilot randomized controlled trial. Int J Clin Exp Med 2014; 7: 4369–77.
    1. Xavier D, Gupta R, Kamath D. Community health worker-based intervention for adherence to drugs and lifestyle change after acute coronary syndrome: a multicentre, open, randomised controlled trial. Lancet Diabetes Endocrinol. 2016;4:244–253.
    2. Xavier D, Gupta R, Kamath D, et al. Community health worker-based intervention for adherence to drugs and lifestyle change after acute coronary syndrome: a multicentre, open, randomised controlled trial. Lancet Diabetes Endocrinol 2016; 4: 244–53.
    1. Ali MK, Singh K, Kondal D. Effectiveness of a multicomponent quality improvement strategy to improve achievement of diabetes care goals: a randomized, controlled trial. Ann Intern Med. 2016;165:399–408.
    2. Ali MK, Singh K, Kondal D, et al. Effectiveness of a multicomponent quality improvement strategy to improve achievement of diabetes care goals: a randomized, controlled trial. Ann Intern Med 2016; 165: 399–408.
    1. Jayasuriya R, Pinidiyapathirage MJ, Jayawardena R. Translational research for diabetes self-management in Sri Lanka: a randomized controlled trial. Prim Care Diabetes. 2015;9:338–345.
    2. Jayasuriya R, Pinidiyapathirage MJ, Jayawardena R, et al. Translational research for diabetes self-management in Sri Lanka: a randomized controlled trial. Prim Care Diabetes 2015; 9: 338–45.
    1. Adeyemo A, Tayo BO, Luke A, Ogedegbe O, Durazo-Arvizu R, Cooper RS. The Nigerian antihypertensive adherence trial: a community-based randomized trial. J Hypertens. 2013;31:201–207.
    2. Adeyemo A, Tayo BO, Luke A, Ogedegbe O, Durazo-Arvizu R, Cooper RS. The Nigerian antihypertensive adherence trial: a community-based randomized trial. J Hypertens 2013; 31: 201–07.
    1. Zhu X, Wong FKY, Wu CLH. Development and evaluation of a nurse-led hypertension management model: A randomized controlled trial. Int J Nurs Stud. 2018;77:171–178.
    2. Zhu X, Wong FKY, Wu CLH. Development and evaluation of a nurse-led hypertension management model: A randomized controlled trial. Int J Nurs Stud 2018; 77: 171–78.
    1. Shao H, Chen G, Zhu C. Effect of pharmaceutical care on clinical outcomes of outpatients with type 2 diabetes mellitus. Patient Prefer Adherence. 2017;11:897–903.
    2. Shao H, Chen G, Zhu C, et al. Effect of pharmaceutical care on clinical outcomes of outpatients with type 2 diabetes mellitus. Patient Prefer Adherence 2017; 11: 897–903.
    1. Zhang P, Hu Y-D, Xing F-M, Li C-Z, Lan W-F, Zhang X-L. Effects of a nurse-led transitional care program on clinical outcomes, health-related knowledge, physical and mental health status among Chinese patients with coronary artery disease: a randomized controlled trial. Int J Nurs Stud. 2017;74:34–43.
    2. Zhang P, Hu Y-D, Xing F-M, Li C-Z, Lan W-F, Zhang X-L. Effects of a nurse-led transitional care program on clinical outcomes, health-related knowledge, physical and mental health status among Chinese patients with coronary artery disease: a randomized controlled trial. Int J Nurs Stud 2017; 74: 34–43.
    1. Hasandokht T, Farajzadegan Z, Siadat ZD, Paknahad Z, Rajati F. Lifestyle interventions for hypertension treatment among Iranian women in primary health-care settings: Results of a randomized controlled trial. J Res Med Sci. 2015;20:54–61.
    2. Hasandokht T, Farajzadegan Z, Siadat ZD, Paknahad Z, Rajati F. Lifestyle interventions for hypertension treatment among Iranian women in primary health-care settings: Results of a randomized controlled trial. J Res Med Sci 2015; 20: 54–61.
    1. He J, Irazola V, Mills KT. Effect of a community health worker-led multicomponent intervention on blood pressure control in low-income patients in Argentina: a randomized clinical trial. JAMA. 2017;318:1016–1025.
    2. He J, Irazola V, Mills KT, et al. Effect of a community health worker-led multicomponent intervention on blood pressure control in low-income patients in Argentina: a randomized clinical trial. JAMA 2017; 318: 1016–25.
    1. de Souza CF, Dalzochio MB, Zucatti ATN. Efficacy of an education course delivered to community health workers in diabetes control: a randomized clinical trial. Endocrine. 2017;57:280–286.
    2. de Souza CF, Dalzochio MB, Zucatti ATN, et al. Efficacy of an education course delivered to community health workers in diabetes control: a randomized clinical trial. Endocrine 2017; 57: 280–86.
    1. Wahab KW, Owolabi M, Akinyemi R. Short-term pilot feasibility study of a nurse-led intervention to improve blood pressure control after stroke in Nigeria. J Neurol Sci. 2017;377:116–120.
    2. Wahab KW, Owolabi M, Akinyemi R, et al. Short-term pilot feasibility study of a nurse-led intervention to improve blood pressure control after stroke in Nigeria. J Neurol Sci 2017; 377: 116–20.
    1. Azami G, Soh KL, Sazlina SG. Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. J Diabetes Res. 2018:4930157.
    2. Azami G, Soh KL, Sazlina SG, et al. Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. J Diabetes Res 2018; 4930157.
    1. Huang Y-J, Parry M, Zeng Y, Luo Y, Yang J, He G-P. Examination of a nurse-led community-based education and coaching intervention for coronary heart disease high-risk individuals in China. Asian Nurs Res. 2017;11:187–193.
    2. Huang Y-J, Parry M, Zeng Y, Luo Y, Yang J, He G-P. Examination of a nurse-led community-based education and coaching intervention for coronary heart disease high-risk individuals in China. Asian Nurs Res 2017; 11: 187–93.
    1. Cappuccio FP, Kerry SM, Micah FB, Plange-Rhule J, Eastwood JB. A community programme to reduce salt intake and blood pressure in Ghana [ISRCTN88789643] BMC Public Health. 2006;6:13.
    2. Cappuccio FP, Kerry SM, Micah FB, Plange-Rhule J, Eastwood JB. A community programme to reduce salt intake and blood pressure in Ghana [ISRCTN88789643]. BMC Public Health 2006; 6: 13.
    1. Jafar TH, Hatcher J, Poulter N. Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial. Ann Intern Med. 2009;151:593–601.
    2. Jafar TH, Hatcher J, Poulter N, et al. Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial. Ann Intern Med 2009; 151: 593–601.
    1. Mendis S, Johnston SC, Fan W, Oladapo O, Cameron A, Faramawi MF. Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: a cluster-randomized trial. Bull World Health Organ. 2010;88:412–419.
    2. Mendis S, Johnston SC, Fan W, Oladapo O, Cameron A, Faramawi MF. Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: a cluster-randomized trial. Bull World Health Organ 2010; 88: 412–19.
    1. Mash RJ, Rhode H, Zwarenstein M. Effectiveness of a group diabetes education programme in under-served communities in South Africa: a pragmatic cluster randomized controlled trial. Diabet Med. 2014;31:987–993.
    2. Mash RJ, Rhode H, Zwarenstein M, et al. Effectiveness of a group diabetes education programme in under-served communities in South Africa: a pragmatic cluster randomized controlled trial. Diabet Med 2014; 31: 987–93.
    1. Fairall LR, Folb N, Timmerman V. Educational outreach with an integrated clinical tool for nurse-led non-communicable chronic disease management in primary care in South Africa: a pragmatic cluster randomised controlled trial. PLoS Med. 2016;13:1–27.
    2. Fairall LR, Folb N, Timmerman V, et al. Educational outreach with an integrated clinical tool for nurse-led non-communicable chronic disease management in primary care in South Africa: a pragmatic cluster randomised controlled trial. PLoS Med 2016; 13: 1–27.
    1. Tian M, Ajay VS, Dunzhu D. A cluster-randomized, controlled trial of a simplified multifaceted management program for individuals at high cardiovascular risk (SimCard trial) in rural Tibet, China, and Haryana, India. Circulation. 2015;132:815–824.
    2. Tian M, Ajay VS, Dunzhu D, et al. A cluster-randomized, controlled trial of a simplified multifaceted management program for individuals at high cardiovascular risk (SimCard trial) in rural Tibet, China, and Haryana, India. Circulation 2015; 132: 815–24.
    1. Goudge J, Chirwa T, Eldridge S. Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa. BMJ Glob Health. 2018;3:e000577.
    2. Goudge J, Chirwa T, Eldridge S, et al. Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa. BMJ Glob Health 2018; 3: e000577.
    1. Neupane D, McLachlan CS, Mishra SR. Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN): an open-label, cluster-randomised trial. Lancet Glob Health. 2018;6:e66–e73.
    2. Neupane D, McLachlan CS, Mishra SR, et al. Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN): an open-label, cluster-randomised trial. Lancet Glob Health 2018; 6: e66–73.
    1. Ogedegbe G, Plange-Rhule J, Gyamfi J. Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: a pragmatic cluster randomized trial in Ghana. PLoS Med. 2018;15:1–17.
    2. Ogedegbe G, Plange-Rhule J, Gyamfi J, et al. Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: a pragmatic cluster randomized trial in Ghana. PLoS Med 2018; 15: 1–17.
    1. Prabhakaran D, Jha D, Prieto-Merino D. Effectiveness of an mHealth-based electronic decision support system for integrated management of chronic conditions in primary care: the mWellcare cluster-randomized controlled trial. Circulation. 2018;139:380–391.
    2. Prabhakaran D, Jha D, Prieto-Merino D, et al. Effectiveness of an mHealth-based electronic decision support system for integrated management of chronic conditions in primary care: the mWellcare cluster-randomized controlled trial. Circulation 2018; 139: 380–91.
    1. Sarfo FS, Treiber F, Gebregziabher M. Phone-based intervention for blood pressure control among Ghanaian stroke survivors: a pilot randomized controlled trial. Int J Stroke. 2018 1747493018816423.
    2. Sarfo FS, Treiber F, Gebregziabher M, et al. Phone-based intervention for blood pressure control among Ghanaian stroke survivors: a pilot randomized controlled trial. Int J Stroke 2018; 1747493018816423.
    1. Coleman R, Gill G, Wilkinson D. Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa. Bull World Health Organ. 1998;76:633–640.
    2. Coleman R, Gill G, Wilkinson D. Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa. Bull World Health Organ 1998; 76: 633–40.
    1. Oparah AC, Adje DU, Enato EF. Outcomes of pharmaceutical care intervention to hypertensive patients in a Nigerian community pharmacy. Int J Pharm Pract. 2006;14:115–122.
    2. Oparah AC, Adje DU, Enato EF. Outcomes of pharmaceutical care intervention to hypertensive patients in a Nigerian community pharmacy. Int J Pharm Pract 2006; 14: 115–22.
    1. Kar SS, Thakur JS, Jain S, Kumar R. Cardiovascular disease risk management in a primary health care setting of north India. Indian Heart J. 2008;60:19–25.
    2. Kar SS, Thakur JS, Jain S, Kumar R. Cardiovascular disease risk management in a primary health care setting of north India. Indian Heart J 2008; 60: 19–25.
    1. Partiprajak S HS, Piaseu N, Brooten D, Nityasuddhi D. Outcomes of an advanced practice nurse-led type-2 diabetes support group. Pac Rim Int J Nurs Res Thail. 2011;15:288–304.
    2. Partiprajak S HS, Piaseu N, Brooten D, Nityasuddhi D. Outcomes of an advanced practice nurse-led type-2 diabetes support group. Pac Rim Int J Nurs Res Thail 2011; 15: 288–304.
    1. Suwanphan A SA, Jiamjarasrangsi W, Sangwatanaroj S. Effectiveness of coronary heart disease risk factors reduction program for hypertensive patients in Thailand. Asian Biomed (Res Rev News) 2010;3:193–199.
    2. Suwanphan A SA, Jiamjarasrangsi W, Sangwatanaroj S, et al. Effectiveness of coronary heart disease risk factors reduction program for hypertensive patients in Thailand. Asian Biomed (Res Rev News) 2010; 3: 193–99.
    1. Kengne AP, Fezeu L, Sobngwi E. Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon. Prim Care Diabetes. 2009;3:181–188.
    2. Kengne AP, Fezeu L, Sobngwi E, et al. Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon. Prim Care Diabetes 2009; 3: 181–88.
    1. Kengne AP, Awah PK, Fezeu LL, Sobngwi E, Mbanya J-C. Primary health care for hypertension by nurses in rural and urban sub-Saharan Africa. J Clin Hypertens. 2009;11:564–572.
    2. Kengne AP, Awah PK, Fezeu LL, Sobngwi E, Mbanya J-C. Primary health care for hypertension by nurses in rural and urban sub-Saharan Africa. J Clin Hypertens 2009; 11: 564–72.
    1. Labhardt ND, Balo J-R, Ndam M, Grimm J-J, Manga E. Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years. BMC Health Serv Res. 2010;10:339.
    2. Labhardt ND, Balo J-R, Ndam M, Grimm J-J, Manga E. Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years. BMC Health Serv Res 2010; 10: 339.
    1. Balagopal P, Kamalamma N, Patel TG, Misra R. A community-based participatory diabetes prevention and management intervention in rural India using community health workers. Diabetes Educ. 2012;38:822–834.
    2. Balagopal P, Kamalamma N, Patel TG, Misra R. A community-based participatory diabetes prevention and management intervention in rural India using community health workers. Diabetes Educ 2012; 38: 822–34.
    1. Sarrafzadegan N, Kelishadi R, Sadri G. Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan Healthy Heart Program. Arch Iran Med. 2013;16:4–11.
    2. Sarrafzadegan N, Kelishadi R, Sadri G, et al. Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan Healthy Heart Program. Arch Iran Med 2013; 16: 4–11.
    1. Reiger S, Harris JR, Chan KCG, Oqueli HL, Kohn M. A community-driven hypertension treatment group in rural Honduras. Glob Health Action. 2015;8:28041.
    2. Reiger S, Harris JR, Chan KCG, Oqueli HL, Kohn M. A community-driven hypertension treatment group in rural Honduras. Glob Health Action 2015; 8: 28041.
    1. Balcázar H, Fernández-Gaxiola AC, Pérez-Lizaur AB, Peyron RA, Ayala C. Improving heart healthy lifestyles among participants in a Salud para su Corazón promotores model: the Mexican pilot study, 2009–2012. Prev Chronic Dis. 2015;12:E34.
    2. Balcázar H, Fernández-Gaxiola AC, Pérez-Lizaur AB, Peyron RA, Ayala C. Improving heart healthy lifestyles among participants in a Salud para su Corazón promotores model: the Mexican pilot study, 2009–2012. Prev Chronic Dis 2015; 12: E34.
    1. Mendoza Montano C, Fort M, deRamirez M, Cruz J, Ramirez-Zea M. Evaluation of a pilot hypertension management programme for Guatemalan adults. Health Promot Int. 2016;31:363–374.
    2. Mendoza Montano C, Fort M, deRamirez M, Cruz J, Ramirez-Zea M. Evaluation of a pilot hypertension management programme for Guatemalan adults. Health Promot Int 2016; 31: 363–74.
    1. Jafar TH, Silva Ad, Naheed A. Control of blood pressure and risk attenuation: a public health intervention in rural Bangladesh, Pakistan, and Sri Lanka: feasibility trial results. J Hypertens. 2016;34:1872–1881.
    2. Jafar TH, Silva Ad, Naheed A, et al. Control of blood pressure and risk attenuation: a public health intervention in rural Bangladesh, Pakistan, and Sri Lanka: feasibility trial results. J Hypertens 2016; 34: 1872–81.
    1. Ajay VS, Jindal D, Roy A. Development of a smartphone-enabled hypertension and diabetes mellitus management package to facilitate evidence-based care delivery in primary healthcare facilities in India: the mPower Heart Project. J Am Heart Assoc. 2016;5:e004343.
    2. Ajay VS, Jindal D, Roy A, et al. Development of a smartphone-enabled hypertension and diabetes mellitus management package to facilitate evidence-based care delivery in primary healthcare facilities in India: the mPower Heart Project. J Am Heart Assoc 2016; 5: e004343.
    1. Marfo AFA, Owusu-Daaku FT. Exploring the extended role of the community pharmacist in improving blood pressure control among hypertensive patients in a developing setting. J Pharm Policy Pract. 2017;10:39.
    2. Marfo AFA, Owusu-Daaku FT. Exploring the extended role of the community pharmacist in improving blood pressure control among hypertensive patients in a developing setting. J Pharm Policy Pract 2017; 10: 39.
    1. Navicharern R AY, Thanasilp S. Effects of multifaceted nurse-coaching intervention on diabetic complications and satisfaction of persons with type 2 diabetes. J Med Assoc Thai. 2009;92:1102–1112.
    2. Navicharern R AY, Thanasilp S. Effects of multifaceted nurse-coaching intervention on diabetic complications and satisfaction of persons with type 2 diabetes. J Med Assoc Thai 2009; 92: 1102–12.
    1. Kamran A, Sharifirad G, Heydari H, Sharifian E. The effect of theory based nutritional education on fat intake, weight and blood lipids. Electron Physician. 2016;8:3333–3342.
    2. Kamran A, Sharifirad G, Heydari H, Sharifian E. The effect of theory based nutritional education on fat intake, weight and blood lipids. Electron Physician 2016; 8: 3333–42.
    1. Flood D, Hawkins J, Rohloff P. A home-based type 2 diabetes self-management intervention in rural Guatemala. Prev Chronic Dis. 2017;14:E65.
    2. Flood D, Hawkins J, Rohloff P. A home-based type 2 diabetes self-management intervention in rural Guatemala. Prev Chronic Dis 2017; 14: E65.
    1. Nelissen HE, Cremers AL, Okwor TJ. Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria—a mixed methods feasibility study. BMC Health Serv Res. 2018;18:934.
    2. Nelissen HE, Cremers AL, Okwor TJ, et al. Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria—a mixed methods feasibility study. BMC Health Serv Res 2018; 18: 934.
    1. Partlett C, Riley RD. Random effects meta-analysis: coverage performance of 95% confidence and prediction intervals following REML estimation. Stat Med. 2017;36:301–317.
    2. Partlett C, Riley RD. Random effects meta-analysis: coverage performance of 95% confidence and prediction intervals following REML estimation. Stat Med 2017, 36: 301–17.
    1. Ogedegbe G, Gyamfi J, Plange-Rhule J. Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials. BMJ Open. 2014;4:e005983.
    2. Ogedegbe G, Gyamfi J, Plange-Rhule J, et al. Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials. BMJ Open 2014; 4: e005983.
    1. Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A. Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries. Cochrane Database Syst Rev. 2015;8 CD011163.
    2. Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A. Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries. Cochrane Database Syst Rev 2015; 8: CD011163.
    1. Gaziano T, Abrahams-Gessel S, Surka S. Cardiovascular disease screening by community health workers can be cost-effective in low-resource countries. Health Aff (Millwood) 2015;34:1538–1545.
    2. Gaziano T, Abrahams-Gessel S, Surka S, et al. Cardiovascular disease screening by community health workers can be cost-effective in low-resource countries. Health Aff (Millwood) 2015; 34: 1538–45.
    1. Mash R, Kroukamp R, Gaziano T, Levitt N. Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa. Patient Educ Couns. 2015;98:622–626.
    2. Mash R, Kroukamp R, Gaziano T, Levitt N. Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa. Patient Educ Couns 2015; 98: 622–26.
    1. Joshi R, Chow CK, Raju PK. The rural Andhra Pradesh cardiovascular prevention study (RAPCAPS): a cluster randomized trial. J Am Coll Cardiol. 2012;59:1188–1196.
    2. Joshi R, Chow CK, Raju PK, et al. The rural Andhra Pradesh cardiovascular prevention study (RAPCAPS): a cluster randomized trial. J Am Coll Cardiol 2012; 59: 1188–96.
    1. Joshi R, Alim M, Kengne AP. Task shifting for non-communicable disease management in low and middle income countries–a systematic review. PLoS One. 2014;9:e103754.
    2. Joshi R, Alim M, Kengne AP, et al. Task shifting for non-communicable disease management in low and middle income countries–a systematic review. PLoS One 2014; 9: e103754.
    1. Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res. 2018;18:350.
    2. Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 2018; 18: 350.
    1. Vedanthan R, Kamano JH, Horowitz CR. Nurse management of hypertension in rural western Kenya: implementation research to optimize delivery. Ann Glob Health. 2014;80:5–12.
    2. Vedanthan R, Kamano JH, Horowitz CR, et al. Nurse management of hypertension in rural western Kenya: implementation research to optimize delivery. Ann Glob Health 2014; 80: 5–12.
    1. Augustovski F, Chaparro M, Palacios A. Cost-effectiveness of a comprehensive approach for hypertension control in low-income settings in argentina: trial-based analysis of the hypertension control program in Argentina. Value Health. 2018;21:1357–1364.
    2. Augustovski F, Chaparro M, Palacios A, et al. Cost-effectiveness of a comprehensive approach for hypertension control in low-income settings in argentina: trial-based analysis of the hypertension control program in Argentina. Value Health 2018; 21: 1357–64.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi