肯尼亚和乌干达社区卫生工作者促进的中重度高血压护理远程医疗:一项随机对照试验。

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2025-06-05 eCollection Date: 2025-06-01 DOI:10.1371/journal.pmed.1004632
Matthew D Hickey, Asiphas Owaraganise, Sabina Ogachi, Norton Sang, Erick M Wafula, Jane Kabami, Nicole Sutter, Jennifer Temple, Anthony Muiru, Gabriel Chamie, Elijah Kakande, Maya L Petersen, Laura B Balzer, Diane V Havlir, Moses R Kamya, James Ayieko
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引用次数: 0

摘要

背景:在撒哈拉以南非洲,高血压未得到充分诊断和治疗。改善初级卫生中心内的高血压治疗可以改善心血管疾病的结局;然而,患有中重度高血压的个体面临着额外的护理障碍,包括需要频繁的诊所访问以滴定药物。我们进行了一项试点研究,以测试临床医生驱动、社区卫生工作者(CHW)促进的远程医疗干预是否能改善乌干达和肯尼亚农村严重高血压成人的高血压控制。方法和研究结果:我们进行了一项随机对照试验(RCT),与临床高血压治疗(NCT04810650)相比,由临床医生通过远程医疗提供高血压治疗(依从性评估、咨询、决策),并由参与者家中的CHW提供帮助。我们招募了年龄≥40岁、血压≥160/100 mmHg的成年人,由CHWs进行家庭筛查,不受HIV感染状况的限制。在诊所进行初步评估后,参与者被随机分配到远程医疗组或临床高血压随访组。除研究统计学家外,随机分配并非盲法。所有参与者都使用标准的国家指南抗高血压药物进行治疗。结论:在该试验中,与临床护理相比,随机对照试验、临床医生驱动、chw促进的高血压管理远程医疗改善了高血压控制,减少了严重高血压。针对中重度高血压患者的远程医疗是一种有希望改善心血管疾病高危人群预后的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Community health worker-facilitated telehealth for moderate-severe hypertension care in Kenya and Uganda: A randomized controlled trial.

Background: Hypertension is underdiagnosed and undertreated in sub-Saharan Africa. Improving hypertension treatment within primary health centers can improve cardiovascular disease outcomes; however, individuals with moderate-severe hypertension face additional barriers to care, including the need for frequent clinic visits to titrate medications. We conducted a pilot study to test whether a clinician-driven, community health worker (CHW)-facilitated telehealth intervention would improve hypertension control among adults with severe hypertension in rural Uganda and Kenya.

Methods and findings: We conducted a pilot randomized controlled trial (RCT) of hypertension treatment delivered via telehealth by a clinician (adherence assessment, counseling, decision-making) and facilitated by a CHW in the participant's home, compared to clinic-based hypertension care (NCT04810650). We recruited adults ≥40 years with BP ≥ 160/100 mmHg at household screening by CHWs, with no restrictions by HIV status. After initial evaluation at the clinic, participants were randomized to telehealth or clinic-based hypertension follow-up. Randomization assignment was not blinded, except for the study statistician. All participants were treated using standard country guideline-based antihypertensive drugs. The primary outcome was hypertension control at 24 weeks (BP < 140/90 mmHg). We also assessed hypertension control at 48 weeks. In intention-to-treat analyses, we compared outcomes between randomized arms with targeted minimum loss-based estimation using sample-splitting to select optimal adjustment covariates (candidates: age, sex, baseline hypertension severity, and country). We screened 2,965 adults ≥40 years, identifying 266 (9%) with severe hypertension and enrolling 200 (98 telehealth arms, 102 clinic arms). Participants were 67% women, median age of 62 years (Q1-Q3 51-72); 14% with HIV. Week 24 blood pressure was measured in 96/99 intervention and 99/102 control participants; week 24 hypertension control was 77% in telehealth and 51% in clinic arms (risk difference (RD) 26%, 95% confidence interval (CI) [14%, 38%], p < 0.001). Week 48 hypertension control was 86% in telehealth and 44% in clinic arms (RD 42%, 95% CI [30%, 53%], p < 0.001). Three participants died (telehealth: 2, clinic: 1); all deaths were unrelated to the study interventions. Our study was limited by its small sample size, although findings are strengthened by being conducted in three primary health centers across two countries.

Conclusion: In this pilot, RCT, clinician-driven, CHW-facilitated telehealth for hypertension management improved hypertension control and reduced severe hypertension compared to clinic-based care. Telehealth focused on individuals with moderate-severe hypertension is a promising approach to improve outcomes among those with the highest risk for CVD.

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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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