背景:联邦首都地区的医疗保健工作者(HCWs),包括社区健康推广工作者(CHEWs),尼日利亚参加了社区医疗保健成果扩展(ECHO)模型之后的高血压培训系列,该模型利用技术和实用的对等学习框架来虚拟培训医疗保健从业人员。我们试图评估高血压ECHO系列的患者水平效果。
方法:选择来自尼日利亚高血压治疗计划(NCT04158154)的33个合格初级保健中心(PHCs)中的12个的HCWs参加了2022年8月至2023年4月的七部分高血压ECHO系列。同时在尼日利亚高血压治疗项目的患者数据被用来评估高血压治疗和控制率的变化,并坚持尼日利亚的高血压治疗方案。比较了ECHO计划中的12个PHC和没有的21个PHC的结果。
结果:在2022年7月至2023年6月之间,记录了4340个人中的16,691例PHC访问(ECHO:n=1428[33%],非回声:n=2912[67%])。患者平均(SD)51.5(12.0)岁,1/3为男性(n=1372,32%),两组间任一特征均无差异(两者p≥0.05).与非ECHO队列相比,ECHO队列中的血压更高(收缩压p<0.0001,舒张压p=0.0001),患者接受多种药物治疗的可能性较小(p<0.0001)。基线时的治疗率相似(ECHO:94.0%和非ECHO:94.7%),并且随着时间的推移,ECHO队列中的治疗率以更高的速率增加(相互作用p=0.045)。在调整基线和现场变化后,差异减弱(相互作用p=0.37).随着时间的推移,控制率增加,药物方案依从性下降,队列之间没有差异。人员配备水平,成人患者就诊,ECHO和非ECHO队列的高血压筛查和强化率相似(均p≥0.05).
结论:ECHO系列与适度增加的高血压治疗率有关,并没有对联邦首都地区PHC的人员配备或临床能力产生不利影响,尼日利亚。这些结果可用于提供策略,以支持在整个尼日利亚的一线医护人员中扩大高血压教育,并将ECHO模型用于CHEW。
背景:尼日利亚高血压治疗计划于2019年11月8日在www上进行了前瞻性注册。
结果:gov(NCT04158154;https://clinicaltrials.gov/ct2/show/NCT04158154)。
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.
BACKGROUND: The Hypertension Treatment in Nigeria Program was prospectively registered on November 8, 2019 at www.
RESULTS: gov (NCT04158154; https://clinicaltrials.gov/ct2/show/NCT04158154 ).