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Abstract
BackgroundHypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and insufficient human resource capacity is among the contributing factors. Thus, a critical component of hypertension management is to develop novel and effective solutions to the human resources challenge. One potential solution is task redistribution and nurse management of hypertension in these settings. ObjectivesThe aim of this study is to investigate whether nurses can effectively reduce blood pressure in hypertensive patients in rural western Kenya and, by extension, throughout sub-Saharan Africa. MethodsAn initial phase of qualitative inquiry will assess facilitators and barriers of nurse management of hypertension. In addition, we will perform usability and feasibility testing of a novel, electronic tablet-based integrated decision-support and record-keeping tool for the nurses. An impact evaluation of a pilot program for nurse-based management of hypertension will be performed. Finally, a needs-based workforce estimation model will be used to estimate the nurse workforce requirements for stable, long-term treatment of hypertension throughout western Kenya. FindingsThe primary outcome measure of the impact evaluation will be the change in systolic blood pressure of hypertensive individuals assigned to nurse-based management after 1 year of follow-up. The workforce estimation modeling output will be the full-time equivalents of nurses. ConclusionsThis study will provide evidence regarding the effectiveness of strategies to optimize task redistribution and nurse-based management of hypertension that can be applicable to noncommunicable disease management in low- and middle-income countries.
Highlights
Hypertension is the leading global risk factor for mortality
The primary outcome measure of the impact evaluation will be the change in systolic blood pressure of hypertensive individuals assigned to nurse-based management after one year of follow-up
This study will provide evidence regarding the effectiveness of strategies to optimize task redistribution and nurse-based management of hypertension that can be applicable to non-communicable disease management in low- and middle-income countries
Summary
Cardiovascular disease (CVD) is the leading cause of mortality in the world, with 80% of CVD deaths occurring in low- and middle-income countries (LMICs).(1) Hypertension, a major risk factor for ischemic heart disease, heart failure, and stroke, [2] is the leading global risk for mortality. [3] The global cost of suboptimal blood pressure (BP) is estimated to be nearly $1 trillion over the decade. [4] Unless adequately controlled, hypertension will continue to be responsible for significant morbidity and mortality worldwide. [5] In sub-Saharan Africa (SSA), CVD is the leading cause of death among individuals over age 30. [6] Several studies in SSA have confirmed a significant prevalence of hypertension that is increasing over time. [7,8,9,10,11,12,13,14,15,16,17,18]. [19] Poor treatment and control of hypertension in LMICs is due to lack of a widespread chronic disease management platform, [20] inadequate access to essential cardiovascular medicines, [21] and insufficient human resources. [22, 25,26,27,28] task redistribution is an essential strategy to meet the human resource challenge of management of chronic diseases such as hypertension and CVD. [29,30,31,32,33,34,35,36,37,38,39,40,41] there have been no rigorous studies examining the feasibility and effectiveness of task redistribution of hypertension care from physicians to nurses in rural LMIC settings. We plan to use a multidisciplinary implementation research approach [42] to evaluate the feasibility and impact of nurse management of hypertension in SSA
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