增强尼日利亚联邦首都特区社区卫生推广人员的高血压教育：社区医疗保健结果扩展模型对初级保健的影响，一项准实验研究。

Enhancing hypertension education of community health extension workers in Nigeria's federal capital territory: the impact of the extension for community healthcare outcomes model on primary care, a quasi-experimental study.

机构信息

Feinberg School of Medicine, Northwestern University, 676 N St. Clair St. Suite 1700, Chicago, IL, 60611, USA.

Robert J Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

出版信息

BMC Prim Care. 2024 Sep 7;25(1):334. doi: 10.1186/s12875-024-02579-y.

DOI:10.1186/s12875-024-02579-y

PMID:39244554

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11380766/

Abstract

BACKGROUND

Healthcare workers (HCWs) including community health extension workers (CHEWs) in the Federal Capital Territory, Nigeria participated in a hypertension training series following the Extension for Community Healthcare Outcomes (ECHO) model which leverages technology and a practical peer-to-peer learning framework to virtually train healthcare practitioners. We sought to evaluate the patient-level effects of the hypertension ECHO series.

METHODS

HCWs from 12 of 33 eligible primary healthcare centers (PHCs) in the Hypertension Treatment in Nigeria Program (NCT04158154) were selected to participate in a seven-part hypertension ECHO series from August 2022 to April 2023. Concurrent Hypertension Treatment in Nigeria Program patient data were used to evaluate changes in hypertension treatment and control rates, and adherence to Nigeria's hypertension treatment protocol. Outcomes were compared between the 12 PHCs in the ECHO program and the 21 which were not.

RESULTS

Between July 2022 and June 2023, 16,691 PHC visits were documented among 4340 individuals (ECHO: n = 1428 [33%], non-ECHO: n = 2912 [67%]). Patients were on average (SD) 51.5 (12.0) years old, and one-third were male (n = 1372, 32%) with no differences between cohorts in either characteristic (p ≥ 0.05 for both). Blood pressures at enrollment were higher in the ECHO cohort compared to the non-ECHO cohort (systolic p < 0.0001 and diastolic p = 0.0001), and patients were less likely to be treated with multiple medications (p < 0.0001). Treatment rates were similar at baseline (ECHO: 94.0% and Non-ECHO: 94.7%) and increased at a higher rate (interaction p = 0.045) in the ECHO cohort over time. After adjustment for baseline and within site variation, the difference was attenuated (interaction p = 0.37). Over time, control rates increased and medication protocol adherence decreased, with no differences between cohorts. Staffing levels, adult patient visits, and rates of hypertension screening and empanelment were similar between ECHO and non-ECHO cohorts (p ≥ 0.05 for all).

CONCLUSIONS

The ECHO series was associated with moderately increased hypertension treatment rates and did not adversely affect staffing or clinical capacity among PHCs in the Federal Capital Territory, Nigeria. These results may be used to inform strategies to support scaling hypertension education among frontline HCWs throughout Nigeria, and use of the ECHO model for CHEWs.

TRIAL REGISTRATION

The Hypertension Treatment in Nigeria Program was prospectively registered on November 8, 2019 at www.

CLINICALTRIALS

gov (NCT04158154; https://clinicaltrials.gov/ct2/show/NCT04158154 ).

摘要

背景

在尼日利亚联邦首都特区，医疗保健工作者（HCWs）包括社区卫生推广工作者（CHEWs）参加了高血压培训系列课程，该系列课程采用延伸社区医疗保健成果（ECHO）模式，利用技术和实际的同行学习框架对医疗保健从业者进行虚拟培训。我们旨在评估高血压 ECHO 系列对患者的影响。

方法

从高血压治疗尼日利亚计划（NCT04158154）中 33 个合格的初级保健中心（PHC）中选择了 12 个 PHC 的 HCWs 参加了 2022 年 8 月至 2023 年 4 月的七个部分高血压 ECHO 系列。同时使用高血压治疗尼日利亚计划的患者数据来评估高血压治疗和控制率的变化，并评估对尼日利亚高血压治疗方案的遵守情况。比较 ECHO 计划中的 12 个 PHC 和未参加的 21 个 PHC 的结果。

结果

2022 年 7 月至 2023 年 6 月，在 4340 名患者中记录了 16691 次 PHC 就诊（ECHO：n=1428 [33%]，非 ECHO：n=2912 [67%]）。患者的平均（SD）年龄为 51.5（12.0）岁，三分之一为男性（n=1372，32%），两组在任何特征上均无差异（p≥0.05）。ECHO 队列的收缩压和舒张压均高于非 ECHO 队列（收缩压 p<0.0001 和舒张压 p=0.0001），且使用多种药物治疗的患者比例较低（p<0.0001）。基线治疗率相似（ECHO：94.0%和非 ECHO：94.7%），ECHO 队列的治疗率随时间呈更高的增长率（交互 p=0.045）。调整基线和站内变异后，差异减弱（交互 p=0.37）。随着时间的推移，控制率增加，药物治疗方案的依从性降低，但两组之间无差异。ECHO 和非 ECHO 队列的工作人员人数、成年患者就诊次数以及高血压筛查和入组率相似（p≥0.05）。