Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina.
Department of Global Health and Populations. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
BMC Public Health. 2021 Mar 22;21(1):567. doi: 10.1186/s12889-021-10569-3.
The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs).
We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC's catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC's staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs).
A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%.
The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.
在阿根廷，仅享受公共卫生保健的人群中，心血管疾病（CVD）预防的有效管理水平较低，因为只有不到 30%的预测 10 年 CVD 风险≥10%的个体在初级保健诊所（PCC）接受 CVD 危险因素控制的临床就诊。
我们采用混合方法进行了一项非对照可行性研究，以评估在公共医疗保健系统中实施的多组分干预措施的可接受性、采用和忠实性。入选标准为：仅享受公共卫生保健、年龄≥40 岁、居住在 PCC 的服务范围内和 10 年 CVD 风险≥10%。多组分干预措施针对（1）通过 PCC 工作人员的任务转移、保护医疗预约时段和新的 CVD 表格来解决系统障碍；（2）通过对初级保健医生和 CHW 的培训以及通过社区卫生工作者（CHW）提供的家庭干预来解决提供者障碍。
共有 185 名参与者被纳入研究。在合格的参与者总数中，82.2%至少参加了一次风险因素控制的临床就诊。对于 BP≥140/90mmHg 的参与者，77%的医生加强了药物治疗，对于患有糖尿病的参与者，79.5%的医生加强了药物治疗，根据 GCP 治疗的参与者比例从高血压参与者的 21%增加到 32.6%，高 CVD 风险参与者的 7.4%增加到 33.3%，极高 CVD 风险参与者的 1.4%增加到 8.7%。在随访结束时，收缩压和舒张压均降低（分别为 156.9 至 145.4mmHg 和 92.9 至 88.9mmHg），高血压的控制（BP<140/90mmHg）从 20.3%增加到 35.5%。
在阿根廷，以 CHW 为主导的干预措施是可行的，且易于被接受，可以改善仅享受公共卫生保健且具有中度或高度 CVD 风险的贫困人群在初级保健机构中对危险因素的发现和治疗。与 CHW 共享任务活动不仅激发了 PCC 工作人员之间的团队合作精神，而且还提高了医疗质量。本研究表明，社区卫生工作者可以在低收入社区中更积极地发现和管理 CVD 危险因素。
