S-36-5: TEAM-BASED CARE TO DIAGNOSE, TREAT AND CONTROL HYPERTENSION: FINDINGS FROM RESOLVE TO SAVE LIVES (RTSL)

Abstract

In order to achieve population-wide control of hypertension, team-based care is essential, especially in low- and middle-income countries (LMIC) where there are insufficient numbers of physicians to diagnose hypertension and prescribe medications. RTSL is a global initiative to dramatically improve hypertension control from 14% to 50% worldwide. One key aspect of our approach to team-based care is generating evidence useful in transforming health care delivery. Types of evidence can broadly be classified as follows: (1) literature synthesis to understand evidence on the types and effects of team-based care for hypertension, and (2) empirical studies of health system changes designed to scale up and improve hypertension care. The empirical studies are typically community-based and involve community health workers (CHWs) who are given greater responsibility beyond basic administrative and clinical tasks. Below are a sample of RTSL studies. Our first study involved understanding the global gap between physician capacity and patient need. We documented that most low- and lower middle income countries did not have the physician capacity to provide 3 annual visit for patients with hypertension (figure). Our principal conclusion is that health system and policy changes are needed, including task-sharing. In a second study, we conducted a meta-analysis and documented that team-based care significantly lowers blood pressure in LMIC, with the extent of blood pressure reduction related to the clinical training of team members. In a third study, we conducted surveys to understand current level of task sharing and barriers to task sharing; few countries allowed non-physicians to conduct advanced clinical tasks, e.g. diagnosing hypertension, initiating treatment, and titrating medications. In a fourth study, MUTU conducted in Nepal, we tested a health system change in which CHWs, under the supervision of a physician, initiated and titrated treatment with amlodipine (MUTU results will be presented at ISH on Oct 16). Currently, we are designing a study in which CHWs, supervised remotely via telemedicine, initiate and titrate medication in persons with untreated hypertension in rural Bangladesh. Other studies involve developing and evaluating training materials for non-physician health care workers and modelling the effects of task shifting on the number of persons treated for hypertension in India, along with associated costs. While these studies are being conducted, many RTSL countries have already implemented health system initiatives that involve team-based care for hypertension. These initiatives studies and RTSL studies hold great promise as a means to improve hypertension control rates in LMIC.