Effectiveness of a provider and patient-focused intervention to improve hypertension management and control in the primary health care setting in Cuba: a controlled before-after study

BMC Primary Care

Research

Fernando Achiong Estupiñán¹  Isabel Carbonell García²  Addys Díaz Piñera³  Armando Rodríguez Salvá³  Tullia Battaglioli⁴  Tom Smekens⁴  Esteban Londoño Agudelo⁵  Patrick Van der Stuyft⁶ 

[1] Centro Provincial de Higiene y Epidemiología, Buena Vista esquina Milanés, Matanzas, Cuba;Centro Provincial de Higiene y Epidemiología, Calle J No. 1 entre 1ra y 2da Reparto Sueño, Santiago de Cuba, Cuba;Centro de Epidemiología y Salud Ambiental, Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta No. 1158 e/ Llinás y Clavel, Centro Habana, 10300, La Habana, Cuba;Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000, Antwerp, Belgium;Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia, Calle 62 #52-59, Medellín, Colombia;Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University. Campus UZ-Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium;Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000, Antwerp, Belgium;Facultad de Medicina, Universidad CES, Calle 10A #22-04, Medellín, Colombia;Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University. Campus UZ-Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium;

关键词: Hypertension;    Chronic diseases;    Primary health care;    Family practice;    Implementation research;    Latin America;    Cuba;   

DOI  :  10.1186/s12875-022-01959-6

 received in 2022-02-15, accepted in 2022-12-26,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundImplementation research to improve hypertension control is scarce in Latin America. We assessed the effectiveness of an intervention aimed at primary care practitioners and hypertensive patients in a setting that provides integrated care through an accessible network of family practices.MethodsWe conducted in Cardenas and Santiago, Cuba, a controlled before-after study in 122 family practices, which are staffed with a doctor and a nurse. The intervention comprised a control arm (usual care), an arm with a component targeting providers (hypertension management workshops), and an arm with, on top of the latter, a component targeting patients (hypertension schools). To evaluate the effect, we undertook a baseline survey before the intervention and an endline survey sixteen months after its start. In each survey, we randomly included 1400 hypertensive patients. Controlled hypertension, defined as a mean systolic and diastolic blood pressure below 140 and 90 mmHg, respectively, was the primary endpoint assessed. We performed linear and logistic regression with a Generalized Estimating Equations approach to determine if the proportion of patients with controlled hypertension changed following the intervention.ResultsSeventy-three doctors, including substitutes, and 54 nurses from the 61 intervention family practices attended the provider workshops, and 3308 patients −51.6% of the eligible ones- participated in the hypertension schools. Adherence to anti-hypertensive medication improved from 42% at baseline to 63% at the endline in the intervention arms. Under the provider intervention, the proportion of patients with controlled hypertension increased by 18.9%, from 48.7% at baseline to 67.6% at endline. However, adding the component that targeted hypertensive patients did not augment the effect. Compared to patients in the control arm, the adjusted OR of having controlled hypertension was 2.36 (95% CI, 1.73–3.22) in the provider and 2.00 (95% CI, 1.68–2.37) in the provider plus patient intervention arm.ConclusionsThe intervention’s patient component remains to be fine-tuned. Still, we demonstrate that it is feasible to substantially improve hypertension outcomes by intervention at the primary care level, despite an already relatively high control rate.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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