Weill Cornell Medicine, New York, New York.
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Netw Open. 2024 Aug 1;7(8):e2430213. doi: 10.1001/jamanetworkopen.2024.30213.
The high prevalence of hypertension calls for broad, multisector responses that foster prevention and care services, with the goal of leveraging high-quality treatment as a means of reducing hypertension incidence. Health care system improvements require stakeholder input from across the care continuum to identify gaps and inform interventions that improve hypertension care service, delivery, and retention; system dynamics modeling offers a participatory research approach through which stakeholders learn about system complexity and ways to model sustainable system-level improvements.
To assess the association of simulated interventions with hypertension care retention rates in the Nigerian primary health care system using system dynamics modeling.
DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model used a participatory research approach involving stakeholder workshops conducted in July and October 2022 to gather insights and inform the development of a system dynamics model designed to simulate the association of various interventions with retention in hypertension care. The study focused on the primary health care system in Nigeria, engaging stakeholders from various sectors involved in hypertension care, including patients, community health extension workers, nurses, pharmacists, researchers, administrators, policymakers, and physicians.
Simulated intervention packages.
Retention rate in hypertension care at 12, 24, and 36 months, modeled to estimate the effectiveness of the interventions.
A total of 16 stakeholders participated in the workshops (mean [SD] age, 46.5 [8.6] years; 9 [56.3%] male). Training of health care workers was estimated to be the most effective single implementation strategy for improving retention in hypertension care in Nigeria, with estimated retention rates of 29.7% (95% CI, 27.8%-31.2%) at 12 months and 27.1% (95% CI, 26.0%-28.3%) at 24 months. Integrated intervention packages were associated with the greatest improvements in hypertension care retention overall, with modeled retention rates of 72.4% (95% CI, 68.4%-76.4%), 68.1% (95% CI, 64.5%-71.7%), and 67.1% (95% CI, 64.5%-71.1%) at 12, 24, and 36 months, respectively.
This decision analytical model study showed that community-based participatory research could be used to estimate the potential effectiveness of interventions for improving retention in hypertension care. Integrated intervention packages may be the most promising strategies.
高血压的高患病率要求采取广泛的多部门措施，以促进预防和护理服务，目标是利用高质量的治疗作为降低高血压发病率的手段。医疗保健系统的改进需要整个护理连续体的利益相关者的投入，以发现差距并为改善高血压护理服务、提供和保留的干预措施提供信息;系统动力学建模提供了一种参与式研究方法，通过这种方法，利益相关者可以了解系统的复杂性以及建模可持续系统级改进的方法。
使用系统动力学建模评估在尼日利亚初级卫生保健系统中模拟干预与高血压护理保留率的关联。
设计、设置和参与者：本决策分析模型采用参与式研究方法，包括 2022 年 7 月和 10 月进行的利益相关者研讨会，以收集见解并为系统动力学模型的开发提供信息，该模型旨在模拟各种干预措施与高血压护理保留率的关联。该研究侧重于尼日利亚的初级卫生保健系统，涉及参与高血压护理的各个部门的利益相关者，包括患者、社区卫生推广工作者、护士、药剂师、研究人员、行政人员、政策制定者和医生。
模拟干预包。
12、24 和 36 个月时高血压护理的保留率，以估计干预措施的有效性。
共有 16 名利益相关者参加了研讨会(平均[SD]年龄 46.5[8.6]岁;9[56.3%]男性)。估计卫生保健工作者的培训是改善尼日利亚高血压护理保留率最有效的单一实施策略，估计 12 个月时的保留率为 29.7%(95%CI，27.8%-31.2%)，24 个月时为 27.1%(95%CI，26.0%-28.3%)。综合干预包与高血压护理保留率的总体提高最为相关，模型预测保留率分别为 72.4%(95%CI，68.4%-76.4%)、68.1%(95%CI，64.5%-71.7%)和 67.1%(95%CI，64.5%-71.1%)，分别为 12 个月、24 个月和 36 个月。
本决策分析模型研究表明，基于社区的参与式研究可用于估计改善高血压护理保留率的干预措施的潜在有效性。综合干预包可能是最有前途的策略。
