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

• 批准号: 10514987
• 负责人: Jiang He
• 金额: $ 137.86万
• 依托单位: UNIVERSITY OF THE WEST INDIES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10514987
• 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 control; burden of illness; cardiovascular disorder risk; cardiovascular risk factor; cluster trial; control trial; cultural health; disability; effectiveness outcome; follow-up; group intervention; hypertension control; hypertensive; 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

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.

项目总结/摘要 高血压对低收入和中等收入国家（LMICs）人口的影响尤为严重，尤其是在 拉丁美洲和加勒比（LAC），流行率高，控制率低， 心血管疾病（CVD）的负担。尽管有广泛的循证干预措施，但只有7.7%的 2010年，LMIC患者的血压（BP）得到控制。缩小知识与实践之间的差距， 为了在拉丁美洲和加勒比地区控制高血压，一个来自哥伦比亚、牙买加和美国的多学科研究小组将 与国家和地方政府机构以及卫生系统合作，测试实施情况， 在哥伦比亚实施和扩大以团队为基础的BP控制护理战略的效果 牙买加。RE-AIM（Reach Effectiveness Adoption Implementation Maintenance）框架 用于指导执行战略的制定和评价。医生-护士（或 药剂师）-社区卫生工作者（CHW）团队将与患者合作，实现共享 治疗目标。护士或药剂师将滴定药物使用一个简单的协议下医生 在督导下，社区卫生工作者会就生活方式的改变和药物的依从性，以及病人 积极进行自我管理（包括家庭血压监测）。具体目标1将测试范围， 实施团队的有效性、采用、实施（忠诚度）和维护（可持续性）- 在一项随机分组试验中，共有40个初级保健诊所（20个来自哥伦比亚，20个来自 来自牙买加;每个诊所32名患者，总计1，280名）将被随机分配到基于团队的护理 战略或加强常规护理12个月，以测试实施和有效性结果。6个月 将进行试验后跟踪研究，以评估可持续性。这项试验有90%的统计效力， 使用双侧显著性检测到高血压控制（BP<140/90 mm Hg）的绝对差异为15% 水平0.05。具体目标2将评估扩大以团队为基础的 观察性研究中的护理策略。将提供培训，以扩大所有剩余地区的团队护理 141个初级保健诊所（78个来自哥伦比亚，63个来自牙买加）。然而， 这些活动将不会得到外部资金的支持。将收集障碍和实施成果 在初级保健诊所和提供者团队层面使用访谈、调查和管理数据。另外我们 将能够比较3个组的实施结果-外部供资的干预措施（诊所 在试验干预组中）、没有外部资金的干预（观察性研究中的诊所），以及 常规护理（试验对照组的诊所）。我们将进行调解分析， 以团队为基础的BP控制护理机制和成本效益分析，以估计实施情况 成本这项拟议的研究将确定有效，公平和可持续的战略，以实现高血压 在常规临床环境中进行控制，并降低LAC和其他LMIC一般人群的CVD风险。