Treating hypertension in rural South Africa: Comparative effectiveness of two different patient outreach models.

南非农村地区的高血压治疗：两种不同患者推广模式的效果比较。

• 批准号: MR/J016020/1
• 负责人: Margaret Thorogood
• 金额: $ 112.52万
• 依托单位: University of Warwick
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2013
• 资助国家: 英国
• 起止时间: 2013 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FJ016020%2F1
• 关键词: Treating; hypertension; rural; South; Africa

The South African Department of Health is currently reorganising the health system to improve care of chronic conditions. The Department of Health has recognised that chronic conditions, including hypertension, are poorly managed in rural, low-resource areas of South Africa. Hypertension is a very common chronic condition, affecting as much as 46% of the adult population, but many people with hypertension remain undiagnosed, are not taking treatment, or do not take their medication consistently. Part of the plan of the Department of Health is for a new cadre of Community Health Workers, six per team with one nurse, making visits to households and responsible for around 270 households. In some areas, including the area where this research will take place, they will also be responsible for delivering medication to people's homes, monitoring clinical indicators, encouraging people with chronic conditions, including hypertension, to take their medication. However, there is concern that this model may prove both too impracticable in rural areas because of the large distances, among other things. We propose to develop and test the effectiveness of a lower resource model in which there is more emphasis on educating and empowering patients to manage their condition. Two lay health workers will be based in a clinic and will support patients with chronic conditions, providing patient education, support to encourage adherence to medication, and texted reminders about clinic appointments and repeat prescriptions. In addition the lay health workers will encourage and support patients to set up self-help groups, which will provide social support but will also provide practical support in fetching medication from the clinics, which are often a long distance from homes. We will carry out a randomised trial comparing the two models of care in 8 clinics in north eastern South Africa, which is a low resource rural area with widely scattered villages. Because we are basing this research in a Health and Demographic Surveillance System site where an annual census is carried out and there is an extensive database of information on the people living on the site, we will be able to identify the people using the clinics so that we can see patterns of use of the clinics and how they change during the trial. This will also mean that we can examine the effects of the two interventions by factors such as how far the household is from the nearest clinic. The census database will also provide a sampling frame for two surveys which will measure the prevalence and control of hypertension in the community before and after the trial.During the trial we will also be using in-depth interviews to study patients, health workers and community members perceptions and experience of the interventions and what are the factors that encourage or discourage either attendance at clinics or adherence to medication.

南非卫生部目前正在重组卫生系统，以改善对慢性病的护理。卫生部认识到，在南非资源匮乏的农村地区，包括高血压在内的慢性病管理不善。高血压是一种非常常见的慢性疾病，影响着多达46%的成年人口，但许多高血压患者仍未得到诊断，没有接受治疗，或者没有坚持服药。卫生部计划的一部分是建立一支新的社区卫生工作者骨干队伍，每队六人，一名护士，走访家庭，负责约270个家庭。在一些地区，包括将进行这项研究的地区，他们还将负责将药物送到人们的家中，监测临床指标，鼓励患有慢性疾病（包括高血压）的人服用药物。然而，人们担心，这种模式在农村地区可能因为路途遥远等原因而太不可行。我们建议开发和测试低资源模式的有效性，在这种模式中，更强调教育和授权患者管理自己的病情。两名非专业卫生工作者将驻扎在一家诊所，为慢性病患者提供支持，提供患者教育，支持鼓励坚持服药，并发短信提醒门诊预约和重复处方。此外，非专业保健工作者将鼓励和支持病人建立自助小组，这些小组将提供社会支持，但也将在从诊所取药方面提供实际支持，这些诊所往往离家很远。我们将在南非东北部的8个诊所进行一项随机试验，比较两种护理模式，这是一个资源匮乏的农村地区，村庄分布广泛。因为我们的研究基于一个健康和人口监测系统网站，该网站每年进行一次人口普查，并且有一个关于居住在该网站上的人的广泛信息数据库，我们将能够识别使用诊所的人，这样我们就可以看到使用诊所的模式以及他们在试验期间的变化。这也意味着我们可以通过诸如家庭离最近的诊所有多远等因素来检查这两种干预措施的效果。普查数据库还将为两项调查提供抽样框架，这些调查将在试验前后测量社区高血压的患病率和控制情况。在试验期间，我们还将使用深度访谈来研究患者、卫生工作者和社区成员对干预措施的看法和经验，以及鼓励或阻碍到诊所就诊或坚持服药的因素是什么。

项目成果

The Nkateko health service trial to improve hypertension management in rural South Africa: study protocol for a randomised controlled trial.

• DOI: 10.1186/1745-6215-15-435
• 发表时间: 2014-11-07
• 期刊: Trials
• 影响因子: 2.5
• 作者: Thorogood M;Goudge J;Bertram M;Chirwa T;Eldridge S;Gómez-Olivé FX;Limbani F;Musenge E;Myakayaka N;Tollman S;Twine R
• 通讯作者: Twine R

Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa.

• DOI: 10.1136/bmjgh-2017-000577
• 发表时间: 2018
• 期刊: BMJ global health
• 影响因子: 8.1
• 作者: Goudge J;Chirwa T;Eldridge S;Gómez-Olivé FXF;Kabudula C;Limbani F;Musenge E;Thorogood M
• 通讯作者: Thorogood M