Can non-physician health-care workers assess and manage cardiovascular risk in primary care?

World Health Organization, Geneva, Switzerland.
Bulletin of the World Health Organisation (Impact Factor: 5.09). 07/2007; 85(6):432-40. DOI: 10.2471/BLT.06.032177
Source: PubMed


To ascertain the reliability of applying the WHO Cardiovascular Risk Management Package by non-physician health-care workers (NPHWs) in typical primary health-care settings.
Based on an a priori 80% agreement level between the NPHWs and the "expert" physicians (gold standard), 649 paired (matched) applications of the protocol were obtained for analysis using Kappa statistic and multivariate logit regression.
Results indicate over 80% agreement between raters, from moderate to perfect levels of agreement in almost all of the sections in the package. The odds of obtaining a difference between raters and a benchmark are not statistically significant.
Applying the WHO Cardiovascular Risk Management Package, NPHWs can be retrained to reliably and effectively assess and manage cardiovascular risks in primary health-care settings where there are no attending physicians. The package could be a useful tool for scaling up the management of cardiovascular diseases in primary health care.

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Available from: Dele Abegunde, Aug 10, 2015
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    • "One such program with respect to CV risk-reduction is the strategy of task-shifting designed to address the multiple layers of the CVD epidemic including screening, counselling on lifestyle modification, initiation of treatment, and referral to specialist care with the use of community health workers [25]. Although the reliability of having community health nurses deliver the WHO strategy for CV risk assessment and optimal hypertension control when compared to ‘expert’ physicians in primary care settings has been established in several LMIC countries [41], its implementation is almost non-existent in SSA. More importantly, in order for task-shifting strategies to be considered effective, evidence of its implementation for addressing the CVD epidemic as part of existing healthcare systems in LMICs are paramount. "
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    ABSTRACT: Background Countries in sub-Saharan Africa (SSA) are experiencing an epidemic of cardiovascular disease (CVD) propelled by rapidly increasing rates of hypertension. Barriers to hypertension control in SSA include poor access to care and high out-of-pocket costs. Although SSA bears 24% of the global disease burden, it has only 3% of the global health workforce. Given such limited resources, cost-effective strategies, such as task shifting, are needed to mitigate the rising CVD epidemic in SSA. Ghana, a country in SSA with an established community health worker program integrated within a national health insurance scheme provides an ideal platform to evaluate implementation of the World Health Organization (WHO) task-shifting strategy. This study will evaluate the comparative effectiveness of the implementation of the WHO Package targeted at CV risk assessment versus provision of health insurance coverage, on blood pressure (BP) reduction. Methods Using a cluster randomized design, 32 community health centers (CHCs) and district hospitals in Ghana will be randomized to either the intervention group (16 CHCs) or the control group (16 CHCs). A total of 640 patients with uncomplicated hypertension (BP 140–179/90–99 mm Hg and absence of target organ damage) will be enrolled in this study (20 patients per CHC). The intervention consists of WHO Package of CV risk assessment, patient education, initiation and titration of antihypertensive medications, behavioral counseling on lifestyle behaviors, and medication adherence every three months for 12 months. The primary outcome is the mean change in systolic BP from baseline to 12 months. The secondary outcomes are rates of BP control at 12 months; levels of physical activity, percent change in weight, and dietary intake of fruits and vegetables at 12 months; and sustainability of intervention effects at 24 months. All outcomes will be assessed at baseline, six months and 12 months. Trained community health nurses will deliver the intervention as part of Ghana’s community-based health planning and services (CHPS) program. Discussion Findings from this study will provide policy makers and other stakeholders needed information to recommend scalable and cost-effective policy with respect to comprehensive CV risk reduction and hypertension control in resource-poor settings. Trial registration NCT01802372.
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    • "An absolute estimation of the 10-year CHD risk (absolute CHD risk (ACR) score) in hypertensive patients is therefore beneficial for determining the appropriate primary prevention strategies to implement in high-risk populations.[21] Using the ACR to bring a hypertensive patient's risk factors to a particular threshold has also proved to be cost-effective because it is a way of preventing hospitalization and avoiding tertiary treatment cost.[19222324] "
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    ABSTRACT: Coronary heart disease (CHD) is the top cause of mortality and morbidity in India. People in slums are generally at a higher risk for CHD than Indians living in more affluent areas mostly because of the higher prevalence of major CHD risk factors such as uncontrolled hypertension and tobacco use amongst them. Knowing their CHD risk perceptions and bringing them into line with the actual CHD risk is a prerequisite for effective CHD risk management. Consequently, there is need to develop tailored interventions focusing medication management and tobacco cessation to reduce growing CHD epidemic among slum dwellers and long-term CHD burden in India.
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    • "Reducing complications in individuals with CVD and diabetes (i) Drug therapy (including glycaemic control for diabetes mellitus) to individuals who have had a heart attack or stroke, and to persons with a high risk (>30%) of a CVD event in the next 10 years; (ii) providing aspirin to people having an acute heart attack. health workers [7] [8]. Protocols and tools to estimate cost of implementation have also been developed to facilitate delivery of these very cost-effective interventions [9] [10]. "

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