Nurse Management of Hypertension in Rural Western Kenya

描述(由申请人提供)：肯尼亚西部农村高血压的护士管理心血管疾病(CVD)是撒哈拉以南非洲30岁以上成年人死亡的主要原因。高血压是心血管疾病的一个主要风险因素，在撒哈拉以南非洲，高血压的患病率随着时间的推移正在增加，给该地区造成了重大的流行病学和经济负担。如果不对高血压进行适当的控制，它的健康和经济负担将在未来几十年急剧增加。已经有了完善的循证干预措施来管理高血压。然而，由于缺乏有效的慢性病管理平台、获得基本药物的机会不足以及人力资源不足等几个原因，治疗和控制率很低。改善高血压护理服务的一种策略是任务转换，即将特定的任务从高素质的卫生工作者“转移”到培训时间较短、资质较低的卫生工作者。因此，该项目的总体目标是利用多学科实施研究方法来优化撒哈拉以南非洲地区高血压护理的提供，重点是涉及高血压护士管理的任务转移战略。候选人是西奈山医学院医学/心脏病学助理教授Rajesh Vedanthan博士，他的目标是成为一名独立的临床调查员，专门从事实施研究，以便在低收入和中等收入国家优化心血管预防和治疗干预措施的提供。他的职业发展计划针对这一职业目标，纳入了一个精心设计的多学科计划，以提供紧张、密切指导的实施研究经验，并结合结构化的教学课程。候选人将与美国国际开发署-学术模式合作，在肯尼亚西部农村地区开展拟议的研究，提供获得医疗保健的机会(AMPATH)伙伴关系。目的1是通过实施快速评估程序，评估高血压患者实施以护士为基础的管理的促进者和障碍。目标2是利用参与性、迭代、以人为中心的设计过程来开发一种基于智能手机的决策支持和集成记录保存(Desire)工具，供护士用于高血压管理。目标3是对AMPATH将实施的以护士为基础的高血压管理试点计划进行影响评估。目标4是使用基于需求的劳动力估计模型来估计稳定、长期治疗高血压的护士劳动力需求。具体目标将在具有互补专业知识的多学科导师和顾问团队的指导下实现。该项目以下列职业目标为指导：1)发展定性方法和基于社区的参与性研究方面的专门知识；2)发展管理科学和人类绩效工程方面的能力；3)获得先进生物统计学和影响评估方法方面的技能；4)获得运筹学和建模方法的知识。 公共卫生相关性：肯尼亚西部农村高血压的护士管理高血压是导致死亡的主要全球风险因素，在未来十年，全球因次优血压造成的成本估计接近1万亿美元。因此，该项目旨在解决低收入和中等收入国家的一个特别关键的健康和发展问题。这项工作的成果将增加在低收入和中等收入国家以及美国和其他高收入国家资源匮乏的情况下有效管理高血压和相关慢性病的可扩展和可持续战略的新兴知识体系。

DESCRIPTION (provided by applicant): Nurse Management of Hypertension in Rural Western Kenya Cardiovascular disease (CVD) is the leading cause of death in sub-Saharan Africa among adults above age 30. The prevalence of hypertension, a major risk factor for CVD, is increasing over time in sub-Saharan Africa, exerting a significant epidemiologic and economic burden on the region. Without adequate control of hypertension, its health and economic burden will increase drastically in the decades ahead. Well established and evidence-based interventions to manage hypertension exist. However, treatment and control rates are low, due to several reasons including lack of an effective chronic disease management platform, inadequate access to essential medicines, and insufficient human resources. One strategy to improve delivery of hypertension care is task-shifting, in which specific tasks are "shifted" from highly qualified health workers to health workers with shorter training and fewer qualifications. Thus, the overall objective of this project is to utilize a multi- disciplinary implementation research approach to optimize delivery of hypertension care in sub-Saharan Africa, focusing on a task-shifting strategy involving nurse management of hypertension. The candidate, Dr. Rajesh Vedanthan, Assistant Professor of Medicine/Cardiology at Mount Sinai School of Medicine, aims to become an independent clinical investigator specializing in implementation research, in order to optimize the delivery of cardiovascular prevention and treatment interventions in low- and middle-income countries. His career development plan, targeted to this career goal, incorporates a multi-disciplinary program carefully designed to provide an intense, closely mentored, implementation research experience in combination with a structured didactic curriculum. The candidate will conduct the proposed research in rural western Kenya in collaboration with the United States Agency for International Development-Academic Model Providing Access to Healthcare (AMPATH) Partnership. Aim 1 is to evaluate facilitators and barriers to implementation of nurse-based management of hypertensive patients, by conducting a rapid assessment procedure. Aim 2 is to utilize a participatory, iterative, human-centered design process to develop a smartphone-based decision support and integrated record-keeping (DESIRE) tool to be used by nurses for hypertension management. Aim 3 is to conduct an impact evaluation of a pilot program for nurse-based management of hypertension to be implemented by AMPATH. Aim 4 is to estimate the nurse workforce requirements for stable, long-term treatment of hypertension using a needs-based workforce estimation model. The specific aims will be accomplished under the guidance of a multidisciplinary team of mentors and advisors with complementary expertise. The project is guided by the following career objectives: 1) develop expertise in qualitative methods and community-based participatory research; 2) develop competence in management sciences and human performance engineering; 3) acquire skills in advanced biostatistical and impact evaluation methods; and 4) acquire knowledge of the methods of operations research and modeling. PUBLIC HEALTH RELEVANCE: Nurse Management of Hypertension in Rural Western Kenya Hypertension is the leading global risk factor for mortality and the global cost of suboptimal blood pressure is estimated to be nearly $1 trillion over the next decade. This project therefore aims to address a singularly critical health and development issue for low- and middle-income countries. The results of this work will add to the emerging body of knowledge on scalable and sustainable strategies for effectively managing hypertension and related chronic diseases in low- and middle-income countries, as well as resource-poor settings in the USA and other high-income countries.