Lay advisor interventions for hypertension outcomes: A Systematic Review, Meta-analysis and a RE-AIM evaluation.

Autor: Patil SJ; Center for Health Equity, Engagement, Education, and Research (CHEEER), Department of Family Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United States., Bhayani V; Department of Public Health, University of Missouri, Columbia, MO, United States., Yoshida Y; Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, United States., Bushweller L; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States., Udoh EO; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States., Todorov I; Department of Wellness and Preventive Medicine, Primary Care Institute, Cleveland Clinic, Cleveland, OH, United States., Saper R; Department of Wellness and Preventive Medicine, Primary Care Institute, Cleveland Clinic, Cleveland, OH, United States., Stange KC; Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, United States., Bolen S; Department of Medicine, Center for Health Care Research and Policy, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United States.
Jazyk: angličtina
Zdroj: Frontiers in medicine [Front Med (Lausanne)] 2024 May 20; Vol. 11, pp. 1305190. Date of Electronic Publication: 2024 May 20 (Print Publication: 2024).
DOI: 10.3389/fmed.2024.1305190
Abstrakt: Introduction: Lay advisor interventions improve hypertension outcomes; however, the added benefits and relevant factors for their widespread implementation into health systems are unknown. We performed a systematic review to: (1) summarize the benefits of adding lay advisors to interventions on hypertension outcomes, and (2) summarize factors associated with successful implementation in health systems using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.
Methods: We systematically searched several databases, including Ovid MEDLINE, CINAHL, PsycINFO from January 1981 to May 2023. All study designs of interventions delivered solely by lay advisors for adults with hypertension were eligible. If both arms received the lay advisor intervention, the study arm with lower intensity was assigned as the low-intensity intervention.
Results: We included 41 articles, of which 22 were RCTs, from 7,267 screened citations. Studies predominantly included socially disadvantaged populations. Meta-analysis (9 RCTs; n  = 4,220) of eligible lay advisor interventions reporting outcomes showed improved systolic blood pressure (BP) [-3.72 mm Hg (CI -6.1 to -1.3; I 2 88%)], and diastolic BP [-1.7 mm Hg (CI -1 to -0.9; I 2 7%)] compared to control group. Pooled effect from six RCTs ( n  = 3,277) comparing high-intensity with low-intensity lay advisor interventions showed improved systolic BP of -3.6 mm Hg (CI -6.7 to -0.5; I 2 82.7%) and improved diastolic BP of -2.1 mm Hg (CI -3.7 to -0.4; I 2 70.9%) with high-intensity interventions. No significant difference in pooled odds of hypertension control was noted between lay advisor intervention and control groups, or between high-intensity and low-intensity intervention groups. Most studies used multicomponent interventions with no stepped care elements or reporting of efficacious components. Indicators of external validity (adoption, implementation, maintenance) were infrequently reported.
Discussion: Lay advisor interventions improve hypertension outcomes, with high intensity interventions having a greater impact. Further studies need to identify successful intervention and implementation factors of multicomponent interventions for stepped upscaling within healthcare system settings as well as factors used to help sustain interventions.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2024 Patil, Bhayani, Yoshida, Bushweller, Udoh, Todorov, Saper, Stange and Bolen.)
Databáze: MEDLINE