Implementing a hypertension management programme in a rural area: local approaches and experiences from Ba-Vi district, Vietnam

Abstract

BackgroundCostly efforts have been invested to control and prevent cardiovascular diseases (CVD) and their risk factors but the ideal solutions for low resource settings remain unclear. This paper aims at summarising our approaches to implementing a programme on hypertension management in a rural commune of Vietnam.MethodsIn a rural commune, a programme has been implemented since 2006 to manage hypertensive people at the commune health station and to deliver health education on CVD risk factors to the entire community. An initial cross-sectional survey was used to screen for hypertensives who might enter the management programme. During 17 months of implementation, other people with hypertension were also followed up and treated. Data were collected from all individual medical records, including demographic factors, behavioural CVD risk factors, blood pressure levels, and number of check-ups. These data were analysed to identify factors relating to adherence to the management programme.ResultsBoth top-down and bottom-up approaches were applied to implement a hypertension management programme. The programme was able to run independently at the commune health station after 17 months. During the implementation phase, 497 people were followed up with an overall regular follow-up of 65.6% and a dropout of 14.3%. Severity of hypertension and effectiveness of treatment were the main factors influencing the decision of people to adhere to the management programme, while being female, having several behavioural CVD risk factors or a history of chronic disease were the predictors for deviating from the programme.ConclusionOur model showed the feasibility, applicability and future potential of a community-based model of comprehensive hypertension care in a low resource context using both top-down and bottom-up approaches to engage all involved partners. This success also highlighted the important roles of both local authorities and a cardiac care network, led by an outstanding cardiac referral centre.

Prevalence, Awareness, Treatment, and Control of High Blood Pressure: A Population-Based Survey in Thai Nguyen, Vietnam

“…However, community-based interventions for enhancing the awareness and control of HTN remain very limited in Vietnam, though with potentially encouraging results. Indeed, a recent study conducted in a rural province of northern Vietnam demonstrated that a community-based model for comprehensive HTN care using both top-down and bottom-up approaches was found to be both feasible and acceptable in this setting [28]. More community-based intervention approaches for HTN control should be investigated.…”

Factors associated with grade 1 hypertension: implications for hypertension care based on the Dietary Approaches to Stop Hypertension (DASH) in primary care settings

“…It has been suggested that community-based preventive measures at population level could largely decrease the morbidity and mortality of cardiovascular and cerebrovascular diseases [ 43 ] which are major adverse outcomes of hypertension at a later stage. In other developing regions worldwide, the implementation of programmes using top-down and bottom-up approaches to identify hypertensive patients and raise their awareness on the diseases in an early stage also demonstrated the effectiveness in hypertension control [ 44 , 45 ].…”

Effects of Guideline-based Hypertension Management in Rural Areas of Guangdong Province

“…Notably, results from a study conducted by Nguyen et al . [ 7 ] showed that delivering knowledge of HTN to community population, implementing lifestyle modification, and improving clinical skill of local medical staff were beneficial for comprehensive management of HTN in a low resource context of Vietnam rural commune.…”

“…Unfortunately, in China, despite improved health system in terms of broadening medical insurance coverage and strengthening the significance of blood pressure management nationwide, the rates of undetected, untreated, and uncontrolled HTN are still up to 40%, 50%, and 80%, respectively, as recently reported by Feng et al . [ 4 ] Taken together, in light of our previous observations and the reports of Nguyen et al .,[ 7 ] our research group conducted a pilot study in Liaobu Town (a rural area of Guangdong province) for the purpose of seeking whether guideline-based HTN management (novel therapy) could effectively and efficiently treat hypertensive population with a relatively less health resources requirement.…”