Uptake of Task shifting strategy for blood pressure control in Community health planning services: A mixed method study

在社区健康规划服务中采用血压控制任务转移策略：混合方法研究

• 批准号: 10254368
• 负责人: Kwaku Poku Asante
• 金额: $ 54.82万
• 依托单位: KINTAMPO HEALTH RESEARCH CENTRE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254368
• 关键词: Acute; Address; Adoption; Adult; Antihypertensive Agents; Caring; Characteristics; Climate; Clinical effectiveness; Communities; Community Health; Community Health Nursing; Community Health Planning; Community Health Services; Consolidated Framework for Implementation Research; Counseling; Country; Discipline of Nursing; District Hospitals; Effectiveness; Epidemic; Evidence based intervention; Feedback; Ghana; Goals; Guidelines; Health; Health Insurance; Health Personnel; Health Planning; Health Services; Human Resources; Hybrids; Hypertension; Income; Insurance Coverage; Intervention; Knowledge; Leadership; Life Style Modification; Literature; Maintenance; Measures; Mediator of activation protein; Methods; Midwifery; Modeling; Morbidity - disease rate; Outcome; Patients; Performance; Pharmaceutical Preparations; Phase; Physicians; Policy Maker; Primary Health Care; Provider; Qualitative Methods; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Resources; Risk; Risk Assessment; Role; Science; Services; System; Technology; Time; Titrations; Training; Universities; base; blood pressure reduction; blood pressure regulation; cardiovascular risk factor; cost effective; design; effectiveness evaluation; effectiveness implementation design; evidence base; hypertension control; implementation barriers; implementation strategy; improved; low and middle-income countries; low income country; medical schools; mortality; outreach; personalized approach; primary care services; primary outcome; programs; provider factors; research to practice; secondary outcome; societal costs; systematic review; treatment as usual; uptake

PROJECT SUMMARY / ABSTRACT This proposal is between the Kwame Nkrumah University of Science and Technology, Kintampo Health Research Center in Ghana and NYU School of Medicine. Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with ONLY one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. Task shifting of primary care duties from physicians to non-physician health workers is a cost-effective strategy for mitigating this problem. In a cluster RCT in 32 health centers in Ghana, we showed that a Task-Shifting Strategy for HTN Control (TASSH) based on the WHO Cardiovascular (CV) Risk Package, delivered by community health nurses (CHNs), led to 34% greater reduction in systolic BP than health insurance coverage among 757 patients. TASSH comprised: 1) CV risk assessment; 2) patient counseling on lifestyle modification, and 3) initiation of antihypertensive medications. Despite its effectiveness, implementation of TASSH across CHPS compounds remains untested because of lack of resources in Ghana. A well-proven strategy to overcome this barrier is practice facilitation (PF) via provision of external expertise on practice redesign, and a tailored approach to implementing guideline-concordant care. CHPS compounds are unique settings to implement TASSH because in CHPS Community Health Officers (CHOs) deliver primary care services. Guided by Consolidated Framework for Implementation Research and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the role of PF on the uptake of TASSH in 70 CHPS compounds. The proposed PF strategy will include a) an advisory board that will provide leadership support for implementing TASSH; and b) trained Practice Outreach Facilitators (CHNs) who will serve as practice coaches and provide support, knowledge exchange and performance feedback to the CHOs who will deliver TASSH at the CHPS compounds. The specific aims are to: (1) Identify practice capacity for the adoption of TASSH at CHPS compounds and develop a culturally tailored PF strategy using qualitative methods; (2a) Evaluate in a stepped- wedge cluster RCT, the effect of PF vs. Usual Care (UC), on the uptake of TASSH (primary outcome) across the CHPS compounds at 12 months;(2b) Compare in a stepped-wedge cluster RCT, the clinical effectiveness of PF vs. UC on systolic BP reduction (secondary outcome) among adults with uncontrolled HTN at 12 months; (3) Evaluate the mediators (implementation climate, leadership support, organizational capacity and provider- level characteristics) of the uptake of TASSH across the CHPS compounds at 12 months; and (4) Evaluate the sustainability of TASSH implementation across the CHPS compounds at 24 months (one year after completion of the trial). Outcomes will be measured at 12 and 24 months in all clusters.

项目摘要/摘要

项目成果

Analysis of the 2007-2018 National Health Interview Survey (NHIS): Examining Neurological Complications among Children with Sickle Cell Disease in the United States.

• DOI: 10.3390/ijerph20126137
• 发表时间: 2023-06-15
• 期刊: International journal of environmental research and public health
• 作者: Peprah E;Gyamfi J;Lee JT;Islam F;Opeyemi J;Tampubolon S;Ojo T;Qiao W;Mai A;Wang C;Vieira D;Meda S;Adenikinju D;Osei-Tutu N;Ryan N;Ogedegbe G
• 通讯作者: Ogedegbe G

Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial.

• DOI: 10.1186/s13063-020-04667-7
• 发表时间: 2020-10-02
• 期刊: Trials
• 影响因子: 2.5
• 作者: Asante KP;Iwelunmor J;Apusiga K;Gyamfi J;Nyame S;Adjei KGA;Aifah A;Adjei K;Onakomaiya D;Chaplin WF;Ogedegbe G;Plange-Rhule J
• 通讯作者: Plange-Rhule J