Efficacy of an education course delivered to community health workers in diabetes control: A randomized clinical trial

Souza, Camila Furtado de; Dalzochio, Mériane Boeira; Zucatti, Alessandra Teixeira Netto; Nale, Rosana de; Almeida, Marília Tavares de; Gross, Jorge Luiz; Leitão, Cristiane Bauermann

doi:10.1007/s12020-017-1352-z

Cited by 12 publications

(23 citation statements)

References 27 publications

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“…Of the 63 studies included in the review, there were 32 randomised controlled trials (from 33 publications),24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56 11 cluster randomised trials,57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67 and 20 before-and-after studies68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87 (appendix pp 3–38). 50 studies were done in Asia and Africa.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies41, 49, 51, 56 did not mention randomisation methods and the randomisation method was unclear in five studies 24, 25, 27, 36, 59. Only 15 of 43 trials reported details of allocation concealment 29, 32, 35, 36, 39, 45, 46, 47, 50, 53, 55, 63, 64, 65, 66, 67. Two studies29, 30 reported participant blinding and 14 studies25, 26, 29, 40, 44, 46, 50, 51, 52, 53, 55, 66 reported outcome assessor blinding.…”

Section: Resultsmentioning

confidence: 99%

“…Home visits were part of the intervention in ten studies 24, 26, 41, 44, 47, 48, 53, 56, 58, 64. Home visits were made to impart or reinforce lifestyle education and for home blood pressure monitoring.…”

Section: Resultsmentioning

confidence: 99%

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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

Anand

Joseph

Geetha

et al. 2019

The Lancet Global Health

146

145

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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, I²=84%) for task sharing with nurses,-8•12 mm Hg (-10•23 to-6•01, I²=57%) for pharmacists,-4•67 mm Hg (-7•09 to-2•24, I²=0%) for dietitians,-3•67 mm Hg (-4•58 to-2•77, I²=24%) for community health workers, and-4•85 mm Hg (-6•12 to-3•57, I²=76%) overall. We found a similar reduction in diastolic blood pressure (overall mean difference-2•92 mm Hg,-3•75 to-2•09, I²=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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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

Anand

Joseph

Geetha

et al. 2019

The Lancet Global Health

146

145

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“…There were nine trials each from Brazil and China. The studies were done in primary health centres (n=10 [22%]), 31,33,35,50,63,65,66,70,72,74 diabetes clinics or community health centres (n=12 [26%]), 32,34,36,45,47-49,51,67,68,71,75 hospitals (n=21 [44%]), 39,[40][41][42][43][44]46,52,53,[55][56][57][58][59][60][61]62,64,69,73,76 and community settings (n=3 [9%]). 37,38,54 The sample size ranged from 53 participants 65 to 4393 participants.…”

Section: Resultsmentioning

confidence: 99%

“…Non-pharmacological inter ventions included assessment, monitoring, lifestyle education, and counselling for the management of diabetes. The interventions were delivered by pharmacists (n=16 [35%]), 41,42,44,45,[52][53][54][55][56]61,62,66,[68][69][70]73 nurses (n=19 [41%]), 31,[33][34][35][36]39,40,43,46,49,57,59,64,65,67,71,72,75,77 dietitians or nutritionists (n=4 [9%]), 47,50,58,74 community health workers (n=5 [11%]), 32,37,38,48,63 or a combination of community health centre staff, nurses, or pharmacists (n=2 [4%]). 51,60 Of the 46 trials, 37 (80%) delivered a non-pharmacological intervention, eight (17%) had both non-pharmacological and pharmacological components, 38,…”

Section: Resultsmentioning

confidence: 99%

Task-sharing interventions for improving control of diabetes in low-income and middle-income countries: a systematic review and meta-analysis

Joseph

Anand

Boban

et al. 2021

The Lancet Global Health

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Background Task-sharing interventions using non-physician health-care workers might be a potential diabetes management strategy in health systems that are constrained by physician shortages, such as those in low-income and middle-income countries (LMICs). Methods We did a systematic review and meta-analysis of task-sharing intervention strategies for managing type 2 diabetes in LMICs. We searched PubMed, Embase, and CINAHL from database inception to Sept 25, 2019, for studies that were randomised control trials or cluster randomised trials with task-shifted or task-shared interventions delivered to adults (≥18 years) by non-physician health workers versus usual care, done in LMICs with glycated haemoglobin (HbA 1c) or fasting blood sugar (FBS) as outcome measures. The methodological quality of included studies was assessed using the Cochrane risk of bias tool. Random-effects model meta-analysis was used to estimate the population average pooled mean difference for HbA 1c and FBS with 95% CIs. Our study protocol was registered in the PROSPERO database (CRD42018081015). Findings We found 4213 studies from the literature search, of which 46 (1•1%) were eligible for the narrative synthesis, including a total of 16 973 participants. 16 of these studies were excluded from the meta-analysis due to high risk of bias. 24 studies with a total of 5345 participants were included in the meta-analysis of HbA 1c and 18 studies with a total of 3287 participants for FBS. Interventions led to an average reduction in HbA 1c when tasks were delivered by nurses (averaged pooled mean difference −0•54% [95% CI −0•89 to −0•18]; I²=80%) and pharmacists (−0•91% [−1•15 to −0•68]; I²=58%), but not when they were delivered by dietitians (−0•50% [-1•10 to 0•09]; I²=54%) or community health workers (0•05% [0•03 to 0•07]; I²=0%). A reduction in average FBS was also observed when interventions were delivered by pharmacists (average pooled mean difference-36•26 mg/dL [-52•60 to-19•92]; I²=78%) but not nurses (-7•46 mg/dL [-18•44 to 3•52]; I²=79%) or community health workers (-5•41 [-12•74 to 1•92]; I²=71%). Only one study reported on FBS when tasks were delivered by dietitians, with a mean difference of-35•00 mg/dL (-65•96 to-4•04). Interpretation Task sharing interventions with non-physician healthcare workers show moderate effectiveness in diabetes management in LMIC settings. Although relatively high heterogeneity limits the interpretation of the overall findings, interventions led by pharmacists and nurses in LMICs with relatively high physician density are effective strategies in the management of diabetes.

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Determining the frequency and level of task-sharing for hypertension management in LMICs: A systematic review and meta-analysis

et al. 2022

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Efficacy of an education course delivered to community health workers in diabetes control: A randomized clinical trial

Abstract: In this study, a significant decrease in HbA1c was observed during patients' follow-up, but it was similar in intervention and control groups. The diabetes mellitus education course delivered to community health workers was able to improve patients' lipid profile.

Cited by 12 publications

References 27 publications

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

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

Task-sharing interventions for improving control of diabetes in low-income and middle-income countries: a systematic review and meta-analysis

Determining the frequency and level of task-sharing for hypertension management in LMICs: A systematic review and meta-analysis

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