印度农村中风患者血压控制的社区卫生志愿者：随机对照试验试点

Community health volunteer for blood pressure control in rural people with stroke in India: Pilot randomised trial.

作者信息

Kate Mahesh Pundlik, Samuel Clarence, Singh Shavinder, Jain Maneeta, Kamra Deepshikha, Singh G B, Sharma Meenakshi, Pandian Jeyaraj Durai

机构信息

Associate Professor, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 7-132C Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G2E3, Canada.

Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India.

出版信息

J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107107. doi: 10.1016/j.jstrokecerebrovasdis.2023.107107. Epub 2023 Mar 30.

DOI:10.1016/j.jstrokecerebrovasdis.2023.107107

PMID:37003249

Abstract

OBJECTIVE

To test the hypothesis that an Accredited social health activist (ASHA), a community health volunteer in a task-sharing model can help in sustained control of systolic blood pressure (BP) in rural people with Stroke and hypertension at 6 months follow up.

METHODS

In this randomized trial two rural areas (Pakhowal and Sidhwan bet) with 70 and 94 villages respectively were screened for people with stroke and hypertension. They were assigned to either ASHA-assisted BP control in addition to standard-of-care (Pakhowal-intervention Group) or standard-of-care alone (Sidhwan bet- Control Group). Assessors blinded to intervention conducted the baseline and 6 months follow-up visits to measure risk factors in both the rural areas.

RESULTS

A total of 140 people with stroke with mean age of 63.7 ± 11.5 years and 44.3% females were randomised. The baseline systolic BP was higher in the intervention group (n = 65,173.5 ± 22.9 mmHg) compared to the control group (n = 75,163 ± 18.7 mmHg, p = 0.004). The follow-up systolic BP was lower in the intervention group compared to the control group 145 ± 17.2 mmHg and 166.6 ± 25.7 mmHg respectively (p < 0.0001). According to the intention-to-treat analysis a total of 69.2% of patients in the intervention group achieved systolic BP control compared to 18.9% in the control group patients (OR 9, 95% CI 3.9-20.3; p < 0.0001).

CONCLUSION

Task sharing with ASHA a community health volunteer can improve BP control in rural people with stroke and hypertension. They can also help in the adoption of healthy behaviour.

CLINICAL TRIAL REGISTRATION NUMBER

ctri.nic.in, CTRI/2018/09/015709.

摘要

目的

检验以下假设：在任务分担模式下，经认证的社会健康活动家（ASHA），即一名社区健康志愿者，能够在6个月的随访中帮助农村中风和高血压患者持续控制收缩压。

方法

在这项随机试验中，分别对拥有70个和94个村庄的两个农村地区（帕科瓦尔和锡德万贝德）进行了中风和高血压患者筛查。他们被分配到除标准治疗外还接受ASHA辅助血压控制的组（帕科瓦尔干预组）或仅接受标准治疗的组（锡德万贝德对照组）。对干预不知情的评估人员对两个农村地区进行了基线和6个月随访，以测量危险因素。

结果

总共140名中风患者被随机分组，平均年龄为63.7±11.5岁，女性占44.3%。干预组（n = 65，收缩压173.5±22.9mmHg）的基线收缩压高于对照组（n = 75，收缩压163±18.7mmHg，p = 0.004）。干预组的随访收缩压低于对照组，分别为145±17.2mmHg和166.6±25.7mmHg（p < 0.0001）。根据意向性分析，干预组共有69.2%的患者实现了收缩压控制，而对照组患者为18.9%（比值比9，95%置信区间3.9 - 20.3；p < 0.0001）。