Improved blood pressure control via a novel chronic disease management model of care in sub-Saharan Africa: Real-world program implementation results

Abstract

A chronic disease management model of care (Empower Health) was launched in rural and urban areas of Ghana and Kenya in 2018. The goal was to improve disease awareness, reduce the burden of disease, and improve the clinical effectiveness and efficiency of managing hypertension. Leveraging the model, clinicians provide patients with tailored management plans. Patients accessed regular blood pressure checks at home, at the clinic, or at community-partner locations where they received real-time feedback. On the mobile application, clinicians viewed patient data, provided direct patient feedback, and wrote electronic prescriptions accessible through participating pharmacies. To date, 1266 patients had been enrolled in the "real-world" implementation cohort and followed for an average of 351 ± 133 days across 5 facilities. Average baseline systolic blood pressure (SBP) was 145 ± 21 mmHg in the overall cohort and 159 ± 16 mmHg in the subgroup with uncontrolled hypertension (n = 743) as defined by baseline SBP ≥ 140 mmHg. SBP decreased significantly through 12 months in both the overall cohort (-9.4 mmHg, p < .001) and in the uncontrolled subgroup (-17.6 mmHg, p < .001). The proportion patients with controlled pressure increased from 46% at baseline to 77% at 12 months (p < .001). In summary, a new chronic disease management model of care improved and sustained blood pressure control to 12 months, especially in those with elevated blood pressure at enrollment.

Keywords: Ghana; Kenya; blood pressure control; digital health; hypertension; innovation; model of care.

FIGURE 1

Hypertension management model of care: The locally appropriate model of care was developed using human‐centered design methodology and included community‐based screening, personalized care plans, community‐based blood pressure monitoring, remote management, and follow‐up and electronic prescription generation

FIGURE 2

Systolic blood pressure at enrollment, 3, 6, 9, and 12 months following enrollment in Empower Health for all patients. Reduction in blood pressure was estimated via a piecewise linear mixed model and was significantly reduced over 12 months in the full cohort and in the subgroup with uncontrolled BP at baseline (p < .001). Selection of knot was determined by LOESS analysis with knots at day 120 for the full cohort and uncontrolled subgroup, and day 210 for the controlled subgroup

FIGURE 3

Changes in blood pressure following enrollment in Empower Health at 12 months follow up period for all patients enrolled (blue), uncontrolled hypertension (red), and controlled hypertension (gray). Data are mean (95% CI)

FIGURE 4

Proportion of population with systolic blood pressure controlled below 140 mmHg at 3, 6, 9, and 12 months: Based on regression modeling, the proportion of subjects with controlled hypertension increased from 48.8% at baseline to 69.9% at 12 months (p < .001)