Non-physician care reduces heart disease and stroke risk
Care led by non-physician health workers, with support from family and free medications, more than doubled control of hypertension and significantly reduced risk of heart disease and stroke compared to usual care, a study published in The Lancet shows.
The randomised controlled trial of 1371 adults in two countries found a substantial reduction in the risk of cardiovascular disease, the world’s leading cause of death, could be achieved in a year with a new comprehensive approach.
In the ‘Hope 4’ trial, care was led by non-physician health workers using a computer tablet to help decision-making, working closely with physicians.
Non-physician led care was supported by counselling to improve health behaviours in people with high blood pressure, two or more free blood pressure-lowering drugs, a statin and help from family and friends as treatment supporters.
This comprehensive approach reduced participants’ blood pressure and risk of a future heart attack or stroke by more than double the amount compared to those who received treatment only from physicians, the study said.
“Governments around the world have agreed on an ambitious goal to reduce cardiovascular mortality by 30% by 2030,” research leader Dr Jon-David Schwalm, of McMaster University, Canada said.
“But we will only achieve this goal if we can find novel ways to remove all barriers to cardiovascular risk reduction, such as access to care, compliance with taking medications, and adoption of healthy behaviours.”
The trial included 1371 adults aged 50 or older from 30 urban and rural communities across Colombia and Malaysia.
Participants had uncontrolled high blood pressure and a raised risk of cardiovascular disease.
A pre-trial appraisal identified barriers to following through with medical treatment, including the time and expense of travelling to attend physician visits, lost wages and costs of drugs.
For the intervention group, which included 14 communities, non-physician health workers led the screening, detection, treatment and control of cardiovascular risk factors.
Health workers were able to respond to participants’ needs, for example by visiting them at home, providing counselling to improve lifestyles and delivering medications.
Prescription recommendations were checked by local physicians, who agreed with health workers’ assessments 93% of the time.
Those in the intervention group also received lifestyle counselling from the health workers using guidance from a tablet-based app, support from family or friends they nominated to help them remember to take medications and to improve their likelihood of sticking to lifestyle changes, a free supply of single-pill antihypertensive medications combining two drugs and a separate statin also provided free of charge.
Participants in the control group (16 communities) were recommended to see their local healthcare provider as usual.
After 12 months, participants treated using the combined strategy reduced their estimated risk of developing cardiovascular disease in the subsequent 10 years by half.
They also achieved a reduction in blood pressure and a reduction in LDL (low-density lipoprotein) cholesterol.
“The unique design of our strategy demonstrates the value of a comprehensive approach which actively involves family and friends as treatment supporters and care being coordinated by trained non-physician health workers guided by a computer program on tablets for diagnosis and counselling,” said Professor Patricio Lopez-Jaramillo from Colombia’s University of Santander.
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