Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative

Abstract

Objective. To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods. From January 2020 to December 2021, St Lucia’s Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results. Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions. The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

Team-Based Approach in Hypertension Management

“…Using an integrated care model approach, this project found significant improvements in patients' BP management and hypertension knowledge. This is similar to other studies 19,21,22,24. The program had an excellent retention rate of 92%, which may have resulted from using multiple communication methods with the participants including portal messages and emails in addition to the in-person discussions with patients that occurred during the visits regarding the importance of BP control and regular follow-ups.…”

“…This indicates that proper measurement techniques and improved disease knowledge led to improved BP control. These project results are similar to findings by the HEARTS initiative, where team-based care including physicians, RNs, community health aides, and CNPs improved hypertension control through collaborative work, standardization of equipment and procedures, healthy lifestyle counseling, and utilization of evidence-based treatment protocols 24. Focusing on an organized population health approach and outreach is better than a patient-clinician-focused approach in improving BP outcomes.…”

“…This is similar to other studies. 19,21,22,24 The program had an excellent retention rate of 92%, which may have resulted from using multiple communication methods with the participants including portal messages and emails in addition to the in-person discussions with patients that occurred during the visits regarding the importance of BP control and regular follow-ups. These various methods of communication could be incorporated into regular medical care to enhance the patient's engagement in their health care.…”

“…These project results are similar to findings by the HEARTS initiative, where team-based care including physicians, RNs, community health aides, and CNPs improved hypertension control through collaborative work, standardization of equipment and procedures, healthy lifestyle counseling, and utilization of evidence-based treatment protocols. 24 Focusing on an organized population health approach and outreach is better than a patientclinician-focused approach in improving BP outcomes. Both Miao et al 22 and Cooper and Zimmerman 19 showed how nurse educational intervention improved patient hypertension control in urban China and a rural community in the United States, respectively.…”

HEARTS en las Américas: impulsar el cambio en el sistema de salud para mejorar el control de la hipertensión en la población

“…Santa Lucía es uno de los pocos países del mundo que inicia el tratamiento de la hipertensión prescribiendo dosis fijas combinadas desde el primer momento. En ambos países, la iniciativa HEARTS ha sido muy bien recibida tanto por pacientes como por el personal de salud, y los resultados de la primera evaluación indican que la cobertura del programa ha registrado un aumento sostenido [ 73 , 74 ].…”