Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis.
| Autor: | Anand TN; Centre for Chronic Disease Control, New Delhi, India., Joseph LM; Centre for Chronic Disease Control, New Delhi, India., Geetha AV; Public Health Foundation of India, New Delhi, India., Prabhakaran D; Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene & Tropical Medicine, London, UK., Jeemon P; Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. Electronic address: pjeemon@gmail.com. |
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| Jazyk: | angličtina |
| Zdroj: | The Lancet. Global health [Lancet Glob Health] 2019 Jun; Vol. 7 (6), pp. e761-e771. |
| DOI: | 10.1016/S2214-109X(19)30077-4 |
| Abstrakt: | Background: Task sharing for the management of hypertension could be useful for understaffed and resource-poor health systems. We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries. Methods: We searched the Cochrane Library, PubMed, Embase, and CINAHL for studies published up to December 2018. We included intervention studies involving a task-sharing strategy for management of blood pressure and other cardiovascular risk factors. We extracted data on population, interventions, blood pressure, and task sharing groups. We did a meta-analysis of randomised controlled trials. Findings: We found 3012 references, of which 54 met the inclusion criteria initially. Another nine studies were included following an updated search. There were 43 trials and 20 before-and-after studies. We included 31 studies in our meta-analysis. Systolic blood pressure was decreased through task sharing in different groups of health-care workers: the mean difference was -5·34 mm Hg (95% CI -9·00 to -1·67, I 2 =84%) for task sharing with nurses, -8·12 mm Hg (-10·23 to -6·01, I 2 =57%) for pharmacists, -4·67 mm Hg (-7·09 to -2·24, I 2 =0%) for dietitians, -3·67 mm Hg (-4·58 to -2·77, I 2 =24%) for community health workers, and -4·85 mm Hg (-6·12 to -3·57, I 2 =76%) overall. We found a similar reduction in diastolic blood pressure (overall mean difference -2·92 mm Hg, -3·75 to -2·09, I 2 =80%). The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure, but low for diastolic blood pressure. Interpretation: Task-sharing interventions are effective in reducing blood pressure. Long-term studies are needed to understand their potential impact on cardiovascular outcomes and mortality. Funding: Wellcome Trust/DBT India Alliance. (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.) |
| Databáze: | MEDLINE |
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