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. 2023 Jul 24;13(7):e072192.
doi: 10.1136/bmjopen-2023-072192.

Landscape of team-based care to manage hypertension: results from two surveys in low/middle-income countries

Oluwabunmi Ogungbe  1 , Danielle Cazabon  2 , Andrew E Moran  2   3 , Dinesh Neupane  4   5 , Cheryl Dennison Himmelfarb  1 , Anbrasi Edward  4 , George W Pariyo  4 , Lawrence J Appel  5   6 , Kunihiro Matsushita  5   6 , Zhang Hongwei  7 , Liu Tong  8 , Girma A Dessie  2 , Addisu Worku  9 , Sohel Reza Choudhury  10 , Shamim Jubayer  10   11 , Mahfuzur Rahman Bhuiyan  10 , Shahinul Islam  10 , Kufor Osi  2 , Joseph Odu  2 , Emmanuel Chijioke Obagha  12 , Dike Ojji  13   14 , Mark D Huffman  15   16   17 , Yvonne Commodore-Mensah  18   6
Affiliations

Landscape of team-based care to manage hypertension: results from two surveys in low/middle-income countries

Oluwabunmi Ogungbe et al. BMJ Open. .

Abstract

Objectives: Team-based care is essential for improving hypertension outcomes in low-resource settings. We assessed perceptions of country representatives and healthcare workers (HCWs) on team-based hypertension care in low/middle-income countries.

Design: Two cross-sectional surveys.

Setting: The first survey (Country Profile Survey) was conducted in 17 countries and eight in-country regions: Algeria, Bangladesh, Burundi, Chile, China (Beijing, Henan, Shandong), Cuba, Ethiopia, India (Kerala, Madhya Pradesh, Maharashtra, Punjab, Telangana), Nepal, Nigeria, Philippines, Saint Lucia, Sri Lanka, Thailand, Turkey, Uganda and Vietnam. The second survey (HCW Survey) was conducted in four countries: Bangladesh, China, Ethiopia and Nigeria.

Participants: Using convenience sampling, participants for the Country Profile Survey were representatives from 17 countries and eight in-country regions, and the HCW Survey was administered to HCWs in Bangladesh, China, Ethiopia and Nigeria.

Outcome measures: Country-level use of team-based hypertension care framework, comprising administrative, basic and advanced clinical tasks. Current practices of different HCW cadres, perspectives on team-based management of hypertension, barriers and facilitators.

Results: In the Country Profile Survey, all (23/23, 100%) countries/regions surveyed integrated team-based care for basic clinical hypertension management tasks, less for advanced tasks (7/23, 30%). In the HCW Survey, 854 HCWs participated, 47% of whom worked in rural settings. Most HCWs in the sample acknowledged the value of team-based hypertension care. Although there were slight variations by country in the study sample, overall, barriers to team-based hypertension care were identified as inadequate training (83%); regulatory issues (76%); resistance by patients (56%), physicians (42%) and nurses (40%). Facilitators identified were use of treatment algorithms (94%), telehealth/m-health technology (92%) and adequate compensation for HCWs (80%).

Conclusions: Our findings revealed key lessons for health systems and governments regarding team-based care implementation. Specifically, policies to facilitate additional training, optimise HCWs' roles within care teams, use of hypertension treatment protocols and telehealth/m-health technology will be essential to promote team-based care.

Keywords: Blood Pressure; Cardiac Epidemiology; EPIDEMIOLOGY; Hypertension; International health services; PUBLIC HEALTH.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Team-based care conceptual framework for hypertension management.
Figure 2
Figure 2
(A) Perceived barriers, (B) perceived facilitators and (C) healthcare workers’ perspectives on team-based hypertension care.
Figure 3
Figure 3
Advanced clinical tasks assignment in practice, by participating country. (A) Initiating treatment per protocol. (B) titrating treatment per protocol and (C) diagnosing hypertension.
See this image and copyright information in PMC

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