Kar Sitanshu Sekhar, Thakur J S, Jain Sanjay, Kumar Rajesh
School of Public Health, Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian Heart J. 2008 Jan-Feb;60(1):19-25.
This study was primarily carried out to assess the feasibility of an adapted WHO CVD risk management package in a primary care setting.
A community intervention trial was conducted in eight health posts located in rural, urban, and slum areas of northern India. After a 4 day training, eight health workers implemented the package among 1010 adults > or =30 years of age from a randomly chosen cluster of households. Locally adapted scenario 1 WHO protocol was used for the assessment of CVD risks. The health workers inquired about smoking, alcohol, diet, physical activity, symptoms of angina, and transient ischaemic attacks; and measured systolic blood pressure (SBP7), height, and weight. Those with a risk were counseled and referred to a physician. Hypertensives were followed at 1, 3, and 5-month interval to reinforce risk prevention and adherence to treatment. In a 20% random sub sample, in the study and control area before and after the intervention, WHO STEPS instrument was used to evaluate effectiveness of the package.
After training, the knowledge of health workers regarding risk factors and symptoms of CVDs increased from 47% to 92.5%, and their performance in detection of risks was comparable to the investigator. All health workers could pay scheduled home visits regularly. They referred 279 (27.6%) individuals having raised systolic blood pressure (SBP), and 74.5% contacted the doctor. Significant decrease in mean SBP (8.8 mm Hg) was observed during follow-up. Significantly higher reports of intention to quit tobacco (60.3% vs 25.5%) and regular intake of anti-hypertensive medication (58.3% vs 34.8%) were observed in the intervention area compared to the control area.
Adapted WHO CVD risk management package can be implemented through primary care system.
本研究主要旨在评估经调整的世界卫生组织心血管疾病风险管理方案在初级保健环境中的可行性。
在印度北部农村、城市和贫民窟地区的八个卫生站开展了一项社区干预试验。经过4天的培训后，八名卫生工作者在从随机选取的一组家庭中挑选出的1010名年龄≥30岁的成年人中实施该方案。采用经当地调整的世界卫生组织方案1来评估心血管疾病风险。卫生工作者询问了吸烟、饮酒、饮食、身体活动、心绞痛症状和短暂性脑缺血发作情况；并测量了收缩压、身高和体重。对有风险的人进行了咨询并转诊给医生。对高血压患者每隔1、3和5个月进行随访，以加强风险预防和治疗依从性。在干预前后，在研究和对照地区的20%随机子样本中，使用世界卫生组织的“STEPS”工具来评估该方案的效果。
培训后，卫生工作者关于心血管疾病危险因素和症状的知识从47%增加到92.5%，他们在风险检测方面的表现与调查人员相当。所有卫生工作者都能定期进行预定的家访。他们转诊了279名（27.6%）收缩压升高的个体，其中74.5%的人联系了医生。随访期间观察到平均收缩压显著下降（8.8毫米汞柱）。与对照地区相比，干预地区观察到戒烟意愿报告（60.3%对25.5%）和定期服用抗高血压药物的报告（58.3%对34.8%）显著更高。
经调整的世界卫生组织心血管疾病风险管理方案可通过初级保健系统实施。
