Evidence map›Paper›PMID 30944139›Full record

ArticleBMJ open2019

Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study.

Alma J Adler, Amos Laar, David Prieto-Merino, Reina M M Der, Debbie Mangortey, Rebecca Dirks, Peter Lamptey, Pablo Perel

Abstract readEvaluation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
41citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

41 citing papers in PubMed, 8 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Alma J Adler *Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Amos Laar *Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana.
David Prieto-MerinoDepartment of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Reina M M DerFHI360, Accra, Ghana.
Debbie MangorteyFHI360, Accra, Ghana.
Rebecca DirksFHI360, Washington, DC, USA.
Peter LampteyDepartment of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Pablo PerelDepartment of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control.

settingLower Manya Krobo, Eastern Region, Ghana.

participantsAll adult hypertensive community members, except pregnant women, were eligible for inclusion in the study. We enrolled 1339 participants, 69% of whom were female. A total of 552 had a 6-month visit, and 338 had a 12-month visit.

interventionsWe report on a package of interventions where community-based cardiovascular disease (CVD) nurses were trained by FHI 360. CVD nurses confirmed diagnoses of known hypertensives and newly screened individuals. Participants were treated according to the clinical guidelines established through the project's Technical Steering Committee. Patients received three types of reminder and adherence messages. We used CommCare, a cloud-based system, as a case management and referral tool. PRIMARY OUTCOME: Hypertension control defined as blood pressure (BP) under 140/90 mm Hg. SECONDARY OUTCOMES: changes in BP and knowledge of risk factors for hypertension.

resultsAfter 1 year of intervention, 72% (95% CI: 67% to 77%) of participants had their hypertension under control. Systolic BP was reduced by 12.2 mm Hg (95% CI: 14.4 to 10.1) and diastolic BP by 7.5 mm Hg (95% CI: 9.9 to 6.1). Due to low retention, we were unable to look at knowledge of risk factors. Factors associated with remaining in the programme for 12 months included education, older age, hypertension under control at enrolment and enrolment date. The majority of patients who remained in the programme were on treatment, with two-thirds taking at least two medications.

conclusionsPatients retained in ComHIP had increased BP control. However, high loss to follow-up limits potential public health impact of these types of programmes. To minimise the impact of externalities, programmes should include standard procedures and backup systems to maximise the possibility that patients stay in the programme.

Indexed as

Practice Patterns, Nurses'AdultAgedBlood PressureBlood Pressure DeterminationCalcium Channel BlockersCommunity Health ServicesDiureticsFemaleGhanaHumansHypertensionMaleMiddle AgedPatient DropoutsProspective StudiesCalcium Channel BlockersDiureticscommunity-based cohort studyGhanahypertension

Identifiers

PMID30944139
PMCPMC6500340

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.