Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa.
Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa.
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DOI：
10.1136/bmjgh-2017-000577
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发表时间：
2018
影响因子：
8.1
通讯作者：
Thorogood M
中科院分区：
文献类型：
--
作者：
Goudge J;Chirwa T;Eldridge S;Gómez-Olivé FXF;Kabudula C;Limbani F;Musenge E;Thorogood M
在艾滋病毒和结核病大量流行的低收入/中等收入国家，保健服务往往忽视其他高度流行的慢性疾病，如高血压，因此管理不善。本文报道了一项研究，旨在评估在南非农村初级保健诊所工作的非专业卫生工作者(LHW)对高血压管理的影响，以支持提供综合慢性护理。一项实用的整群随机试验在8家乡村诊所进行了流程评估，评估了在18个月的时间里，在每个干预诊所增加两名LHW支持护士提供慢性病护理的效果。对照诊所继续照常护理。主要结果衡量指标是通过两项横断面人口调查衡量干预前后临床使用者因高血压(BP)而增加心血管风险的百分比的变化。与对照诊所相比，使用干预诊所的患者在血压控制方面没有改善。然而，LHW改善了诊所的功能，包括总体就诊情况和正确日期的就诊情况。所有诊所都面临许多挑战，包括慢性护理使用者的数量迅速增加、BP机器和袖带不可靠、间歇性药品短缺和空间不足。LHW改善了提供护理的流程，但改善血压控制需要改善护士的临床护理，而这一点受到了大量和不断增加的患者、垂直资助的艾滋病毒方案的主导地位以及诊所设备标准较低的影响。ISRCTN12128227。
In low/middle-income countries with substantial HIV and tuberculosis epidemics, health services often neglect other highly prevalent chronic conditions, such as hypertension, which as a result are poorly managed. This paper reports on a study to assess the effect on hypertension management of lay health workers (LHW) working in South African rural primary healthcare clinics to support the provision of integrated chronic care. A pragmatic cluster randomised trial with a process evaluation in eight rural clinics assessed the effect of adding two LHWs supporting nurses in providing chronic disease care in each intervention clinic over 18 months. Control clinics continued with usual care. The main outcome measure was the change in the difference of percentage of clinic users who had elevated cardiovascular risk associated with high blood pressure (BP) before and after the intervention, as measured by two cross-sectional population surveys. There was no improvement in BP control among users of intervention clinics as compared with control clinics. However, the LHWs improved clinic functioning, including overall attendance, and attendance on the correct day. All clinics faced numerous challenges, including rapidly increasing number of users of chronic care, unreliable BP machines and cuffs, intermittent drug shortages and insufficient space. LHWs improved the process of providing care but improved BP control required improved clinical care by nurses which was compromised by large and increasing numbers of patients, the dominance of the vertically funded HIV programme and the poor standards of equipment in clinics. ISRCTN12128227.
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影响因子：
7.7
作者：
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通讯作者：
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影响因子：
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影响因子：
3.7
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