Feasibility and quality of cardiovascular disease prevention within a community-based health insurance program in rural Nigeria

Abstract

Implementation of CVD prevention care within the context of a CBHI program resulted in high-quality care in rural sub-Saharan Africa, comparable to high-income countries. However, guideline implementation was resource-intense and specific recommendations were not feasible. Simple models of care delivery are needed for rapid scale-up of CVD prevention services in sub-Saharan Africa.

How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study

“…In a previously reported study, Quality Improvement Cardiovascular care Kwara (QUICK)-I, we evaluated the feasibility and quality of this program [28] [34]. The QUICK-I study included 349 insured patients with hypertension and/or diabetes from OOH between June 2010 and January 2011, followed these patients over a period of 12 months and assessed them for health-related and other outcomes, including medication adherence, systolic BP (SBP) and diastolic BP (DBP).…”

“…The QUICK-I study included 349 insured patients with hypertension and/or diabetes from OOH between June 2010 and January 2011, followed these patients over a period of 12 months and assessed them for health-related and other outcomes, including medication adherence, systolic BP (SBP) and diastolic BP (DBP). Of the 349 included patients 323 completed the study at one year of follow up [28].…”

“…A systematic review of studies on various strategies for improving the quality of primary hypertension care in high income countries concludes that organizational health system changes and patient education have the biggest impact on blood pressure (BP) outcomes [26]. Some recent primary care studies from Nigeria also demonstrate that organizational quality improvement interventions can lead to improved clinical outcomes in hypertensive patients [14] [27] [28]. However, to date little information is available about the impact of patient education on hypertension management in low resource communities in Nigeria or other countries in SSA.…”

Costs of cardiovascular disease prevention care and scenarios for cost saving

“…Of these, 294 patients had hypertension only, 28 patients had hypertension and diabetes, and 9 patients had hypertension with a history of stroke, renal disease or angina pectoris. More information about the cohort selection is described elsewhere [13]; baseline characteristics can be found in the Supplemental Digital Content (See Table 1, Supplemental Digital Content 1, http://links.lww.com/HJH/A441, which shows the baseline characteristics of the QUICK cohort).…”

“…A description of the QUICK project is provided elsewhere [12,13]. A micro-costing study was conducted to evaluate the costs of providing CVD prevention care in a primary care setting in rural Nigeria, based on data from the QUICK cohort.…”