Department of Medicine, All India Institute of Medical Sciences, Bhopal, India.
Departments of Pharmacology, Community Medicine, and Division of Clinical Research and Training, St John's Medical College and Research Instiutute, Bangalore, India.
Am Heart J. 2019 Oct;216:9-19. doi: 10.1016/j.ahj.2019.06.007. Epub 2019 Jun 19.
There is a need to identify and test low-cost approaches for cardiovascular disease (CVD) risk reduction that can enable health systems to achieve such a strategy.
Community health workers (CHWs) are an integral part of health-care delivery system in lower income countries. Our aim was to assess impact of CHW based interventions in reducing CVD risk factors in rural households in India.
We performed an open-label cluster-randomized trial in 28 villages in 3 states of India with the household as a unit of randomization. Households with individuals at intermediate to high CVD risk were randomized to intervention and control groups. In the intervention group, trained CHWs delivered risk-reduction advice and monitored risk factors during 6 household visits over 12 months. Households in the non-intervention group received usual care. Primary outcomes were a reduction in systolic BP (SBP) and adherence to prescribed BP lowering drugs.
We randomized 2312 households (3261 participants at intermediate or high risk) to intervention (1172 households) and control (1140 households). At baseline prevalence of tobacco use (48.5%) and hypertension (34.7%) were high. At 12 months, there was significant decline in SBP (mmHg) from baseline in both groups- controls 130.3 ± 21 to 128.3 ± 15; intervention 130.3 ± 21 to 127.6 ± 15 (P < .01 for before and after comparison) but there was no difference between the 2 groups at 12 months (P = .18). Adherence to antihypertensive drugs was greater in intervention vs control households (74.9% vs 61.4%, P = .001).
A 12-month CHW-led intervention at household level improved adherence to prescribed drugs, but did not impact SBP. To be more impactful, a more comprehensive solution that addresses escalation and access to useful therapies is needed.
需要确定和测试可降低心血管疾病（CVD）风险的低成本方法，使卫生系统能够实现这一策略。
社区卫生工作者（CHW）是低收入国家医疗保健提供系统的一个组成部分。我们的目的是评估基于 CHW 的干预措施在降低印度农村家庭 CVD 风险因素方面的效果。
我们在印度 3 个邦的 28 个村庄进行了一项开放标签的群组随机试验，以家庭为随机单位。将具有中高危 CVD 风险的个体的家庭随机分配到干预组和对照组。在干预组中，经过培训的 CHW 在 12 个月内进行了 6 次家访，提供降低风险的建议并监测风险因素。非干预组的家庭接受常规护理。主要结局是收缩压（SBP）降低和遵医嘱使用降压药物。
我们随机分配了 2312 个家庭（3261 名处于中高危的个体）至干预组（1172 个家庭）和对照组（1140 个家庭）。基线时，吸烟率（48.5%）和高血压患病率（34.7%）均较高。12 个月时，两组的 SBP 均有显著下降-对照组从基线的 130.3±21mmHg 降至 128.3±15mmHg；干预组从基线的 130.3±21mmHg 降至 127.6±15mmHg（前后比较 P<.01），但两组间在 12 个月时无差异（P=.18）。干预组的降压药物依从性高于对照组（74.9% vs 61.4%，P=.001）。
在家庭层面上进行为期 12 个月的 CHW 主导的干预措施可提高药物的依从性，但对 SBP 没有影响。为了更有影响力，需要一种更全面的解决方案，解决升级和获得有用疗法的问题。
