Abstract P557: A Landscape Analysis of Team-Based Care for Hypertension Control in Low-and Middle-Income Countries

Abstract

Introduction: A team-based care approach to hypertension care in low-resource settings is an effective strategy for improving hypertension control. Objective: In this multi-country survey, we assessed the extent to which team-based care is operationalized for hypertension care in low- and middle-income countries (LMICs), and the perception of hypertension program experts and health care workers (HCWs). Methods: Two surveys were administered; the first survey (Country Profile Survey), administered in 25 countries, sought to identify the current tasks of HCWs from perspectives of national representatives involved in public health programming. The second survey (HCW Survey), administered among HCWs in four LMICs; Bangladesh, China, Ethiopia, and Nigeria, aimed to understand current practices of HCWs, perspectives on team-based management of hypertension, and barriers and facilitators. Results: In the Country Profile Survey, all countries surveyed allowed team-based care for basic clinical hypertension management tasks, but less for advanced tasks (9/25, 36%). In the HCW survey, 854 HCWs from four countries participated: 47% (401/854) work in rural settings. Although there were slight variations by country, overall, barriers to team-based hypertension care were similar, including: inadequate training of HCWs (83%), regulatory issues (76%), resistance by patients (56%), and opposition by physicians (42%) and nurses (40%). Perceived facilitators of team-based hypertension care were use of treatment algorithms (94%), telehealth/m-health technology (92%), and adequate compensation for HCWs (80%) ( Figure A-B ). Conclusions: These surveys revealed key targets for health systems and governments to facilitate team-based care implementation. Specifically, policies to provide additional training, optimize HCWs roles within the care team, and establish hypertension treatment protocols and telehealth/m-health are essential.