Integrating Community Health Workers into Community-Based Primary Care Practice Settings to Improve Blood Pressure Control Among South Asian Immigrants in New York City: Results from a Randomized Control Trial.
Integrating Community Health Workers into Community-Based Primary Care Practice Settings to Improve Blood Pressure Control Among South Asian Immigrants in New York City: Results from a Randomized Control Trial.
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将社区卫生工作者纳入基于社区的初级保健实践环境，以改善纽约市南亚移民的血压控制：随机对照试验的结果。
DOI：
10.1161/circoutcomes.122.009321
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Trinh-Shevrin,Chau
中科院分区：
文献类型：
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作者：
Islam,NadiaS;Wyatt,LauraC;Ali,ShahmirH;Zanowiak,JenniferM;Mohaimin,Sadia;Goldfeld,Keith;Lopez,Priscilla;Kumar,Rashi;Beane,Susan;Thorpe,LornaE;Trinh-Shevrin,Chau
背景血压控制在少数民族社区，包括亚洲人群中是次优的。我们评估的可行性，采用和综合CHW领导的健康指导和实践层面的干预措施，以改善高血压控制在南亚患者在纽约市，项目IMPACT（整合百万心脏供应商和社区转型）的有效性。主要结局是血压控制，次要结局是收缩压和舒张压在6个月follow-up.MethodsA随机对照试验发生在社区为基础的初级保健的做法，主要服务于南亚患者在纽约市之间2017年和2019年。在14家临床试验机构，共有303例年龄在18-85岁的南亚患者同意参与研究，这些患者在过去6个月内被诊断为高血压和血压不受控制（收缩压≥140 mm Hg或舒张压≥90 mm Hg）。在完成1次教育后，将受试者随机分为治疗组（n=159）和对照组（n=144）。治疗参与者在6个月的时间内接受了4次额外的团体教育课程和个性化健康指导。一个混合效应广义线性模型与logit链接函数被用来评估干预有效性控制高血压（是/否），调整实践水平的随机效应，年龄，性别，基线收缩压，BP measurements.ResultsAmong总入组人群之间的天，平均年龄为56.8±11.2岁，54.1%是女性。在6个月时，在有随访血压数据的个体中（治疗组，n=154;对照组，n=137），治疗组68.2%和对照组41.6%的血压得到控制（P<0.001）。在最后的调整分析，治疗组参与者有3.7 [95%CI，2.1-6.5]倍的几率，实现血压控制在后续comparison.ConclusionsA CHW领导的健康教练干预措施是有效的，在南亚裔美国人在纽约市初级保健的做法。研究结果可以指导该模型在经历高血压差异的其他社区的翻译和传播。RegistrationURL：https://www.clinicaltrials.gov;唯一标识符：NCT 03159533
BackgroundBlood pressure (BP) control is suboptimal in minority communities, including Asian populations. We evaluate the feasibility, adoption, and effectiveness of an integrated CHW-led health coaching and practice-level intervention to improve hypertension control among South Asian patients in New York City, Project IMPACT (Integrating Million Hearts for Provider and Community Transformation). The primary outcome was BP control, and secondary outcomes were systolic BP and diastolic BP at 6-month follow-up.MethodsA randomized-controlled trial took place within community-based primary care practices that primarily serve South Asian patients in New York City between 2017 and 2019. A total of 303 South Asian patients aged 18–85 with diagnosed hypertension and uncontrolled BP (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) within the previous 6 months at 14 clinic sites consented to participate. After completing 1 education session, individuals were randomized into treatment (n=159) or control (n=144) groups. Treatment participants received 4 additional group education sessions and individualized health coaching over a 6-month period. A mixed effect generalized linear model with a logit link function was used to assess intervention effectiveness for controlled hypertension (Yes/No), adjusting for practice level random effect, age, sex, baseline systolic BP, and days between BP measurements.ResultsAmong the total enrolled population, mean age was 56.8±11.2 years, and 54.1% were women. At 6 months among individuals with follow-up BP data (treatment, n=154; control, n=137), 68.2% of the treatment group and 41.6% of the control group had controlled BP (P<0.001). In final adjusted analysis, treatment group participants had 3.7 [95% CI, 2.1–6.5] times the odds of achieving BP control at follow-up compared with the control group.ConclusionsA CHW-led health coaching intervention was effective in achieving BP control among South Asian Americans in New York City primary care practices. Findings can guide translation and dissemination of this model across other communities experiencing hypertension disparities.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03159533