Hinneh Thomas, Boakye Hosea, Metlock Faith, Ogungbe Oluwabunmi, Kruahong Suratsawadee, Byiringiro Samuel, Dennison Himmelfarb Cheryl, Commodore-Mensah Yvonne
School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA.
BMJ Open. 2024 Jul 17;14(7):e080987. doi: 10.1136/bmjopen-2023-080987.
We evaluated the effectiveness of team-based care interventions in improving blood pressure (BP) outcomes among adults with hypertension in Africa.
Systematic review and meta-analysis.
PubMed, CINAHL, EMBASE, Cochrane Library, HINARI and African Index Medicus databases were searched from inception to March 2023.
We included randomised controlled trials (RCTs) and pre-post study designs published in English language focusing on (1) Adults diagnosed with hypertension, (2) Team-based care hypertension interventions led by non-physician healthcare providers (HCPs) and (3) Studies conducted in Africa.
We extracted study characteristics, the nature of team-based care interventions, team members involved and other reported secondary outcomes. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and the National Heart, Lung, and Blood Institute assessment tool for pre-post studies. Findings were summarised and presented narratively including data from pre-post studies. Meta-analysis was conducted using a random effects model for only RCT studies. Overall certainty of evidence was determined using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool for only the primary outcome (systolic BP).
Of the 3375 records screened, 33 studies (16 RCTs and 17 pre-post studies) were included and 11 RCTs were in the meta-analysis. The overall mean effect of team-based care interventions on systolic BP reduction was -3.91 mm Hg (95% CI -5.68 to -2.15, I² = 0.0%). Systolic BP reduction in team-based care interventions involving community health workers was -4.43 mm Hg (95% CI -5.69 to -3.17, I² = 0.00%) and nurses -3.75 mm Hg (95% CI -10.62 to 3.12, I² = 42.0%). Based on the GRADE assessment, we judged the overall certainty of evidence low for systolic BP reduction suggesting that team-based care intervention may result in a small reduction in systolic BP.
Evidence from this review supports the implementation of team-based care interventions across the continuum of care to improve awareness, prevention, diagnosis, treatment and control of hypertension in Africa. CRD42023398900.
我们评估了基于团队的护理干预措施对改善非洲高血压成年人血压（BP）结果的有效性。
系统评价和荟萃分析。
检索了PubMed、CINAHL、EMBASE、Cochrane图书馆、HINARI和非洲医学索引数据库，检索时间从建库至2023年3月。
我们纳入了以英文发表的随机对照试验（RCT）和前后对照研究设计，这些研究关注以下方面：（1）被诊断为高血压的成年人；（2）由非医生医疗服务提供者（HCP）主导的基于团队的高血压护理干预措施；（3）在非洲进行的研究。
我们提取了研究特征、基于团队的护理干预措施的性质、涉及的团队成员以及其他报告的次要结果。使用Cochrane偏倚风险工具对RCT进行偏倚风险评估，使用美国国立心肺血液研究所评估工具对前后对照研究进行评估。研究结果进行了总结并以叙述形式呈现，包括前后对照研究的数据。仅对RCT研究使用随机效应模型进行荟萃分析。仅对主要结局（收缩压）使用推荐分级、评估、制定与评价（GRADE）工具确定证据的总体确定性。
在筛选的3375条记录中，纳入了33项研究（16项RCT和17项前后对照研究），11项RCT纳入了荟萃分析。基于团队的护理干预措施对收缩压降低的总体平均效应为-3.91 mmHg（95%CI -5.68至-2.15，I² = 0.0%）。涉及社区卫生工作者的基于团队的护理干预措施中收缩压降低为-4.43 mmHg（95%CI -5.69至-3.17，I² = 0.00%），护士主导的为-3.75 mmHg（95%CI -10.62至3.12，I² = 42.0%）。根据GRADE评估，我们判断收缩压降低证据的总体确定性较低，表明基于团队的护理干预措施可能导致收缩压有小幅降低。
本综述的证据支持在整个护理过程中实施基于团队的护理干预措施，以提高非洲高血压的知晓、预防、诊断、治疗和控制水平。CRD42023398900。
