Trial reportBMC health services research2022
Network characteristics of a referral system for patients with hypertension in Western Kenya: results from the Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) study.
Trial report in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03543787 (Strengthening Referral Networks for Management of Hypertension Across the Health System), which is not on this map. Cited by 8 papers.
What it found
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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.
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.
Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS)
Who cites it
8 citing papers in PubMed.
- Primary care provider's barriers to effective management of apparently resistant hypertension in Malaysian public primary health care and strategies to overcome them: a qualitative study.BMC primary care · 2026Article
- Integrated Implementation Strategies to Promote the Use of AI-Assisted Diagnostic Software for Lung Nodule Screening in China: Process Evaluation Based on the RE-AIM Framework.JMIR formative research · 2026Article
- Reciprocal innovation in implementation science and global health: reflections from the EXTRA-CVD (extending the HIV treatment cascade for cardiovascular disease prevention) study.BMC global and public health · 2026Review
- Article
- Optimizing people's movement across the health system: a scoping review of referral systems within a primary health care approach.Primary health care research & development · 2025Article
- Does the hierarchical medical system enhance healthcare utilization and equity in China? a longitudinal study 2012-2018.BMC public health · 2025Article
- Network characteristics of referrals for chronic disease patients: results from hierarchical medical reform in Shenzhen, China.BMC public health · 2024Article
- The Challenges of Implementing a Health Referral System in South Africa: A Qualitative Study.Risk management and healthcare policy · 2024Article
Corrections and comments
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Authors and funding
18 authors.
Funding
Abstract
backgroundHealth system approaches to improve hypertension control require an effective referral network. A national referral strategy exists in Kenya; however, a number of barriers to referral completion persist. This paper is a baseline assessment of a hypertension referral network for a cluster-randomized trial to improve hypertension control and reduce cardiovascular disease risk.
methodsWe used sociometric network analysis to understand the relationships between providers within a network of nine geographic clusters in western Kenya, including primary, secondary, and tertiary care facilities. We conducted a survey which asked providers to nominate individuals and facilities to which they refer patients with controlled and uncontrolled hypertension. Degree centrality measures were used to identify providers in prominent positions, while mixed-effect regression models were used to determine provider characteristics related to the likelihood of receiving referrals. We calculated core-periphery correlation scores (CP) for each cluster (ideal CP score = 1.0).
resultsWe surveyed 152 providers (physicians, nurses, medical officers, and clinical officers), range 10-36 per cluster. Median number of hypertensive patients seen per month was 40 (range 1-600). While 97% of providers reported referring patients up to a more specialized health facility, only 55% reported referring down to lower level facilities. Individuals were more likely to receive a referral if they had higher level of training, worked at a higher level facility, were male, or had more job experience. CP scores for provider networks range from 0.335 to 0.693, while the CP scores for the facility networks range from 0.707 to 0.949.
conclusionsThis analysis highlights several points of weakness in this referral network including cluster variability, poor provider linkages, and the lack of down referrals. Facility networks were stronger than provider networks. These shortcomings represent opportunities to focus interventions to improve referral networks for hypertension.
trial registrationTrial Registered on ClinicalTrials.gov NCT03543787 , June 1, 2018.
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