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

Abstract

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.

Barriers, enablers and strategies for the treatment and control of hypertension in Nepal: a mixed-methods systematic review

“…After a very acclaimed performance on improving maternal and child health [63], new evidence suggests that community health workers could potentially work as the frontline cadres to ght against the burden of NCDs, including hypertension [64]. Task sharing, particularly with other non-physician health workers in understaffed and resource-poor settings, is an effective strategy for the management of hypertension [31]. Additionally, other approaches such as including pharmacists and nurses in a team and providing team-based hypertension care also showed positive effects on controlling high blood pressure [32].…”

Long-Term Outcomes of a Cohort of Hypertensive Subjects in Rural Ecuador

“…Comparing the outcomes of our cohort with those of "similar" cohorts would at first sight be interesting even if not needed. A reliable comparison, however, would be impossible and probably inappropriate, not only because of the rarity of field studies with comparable designs [10][11][12][13], but even more because the unavoidable variability of the nonmedical variables and the settings of care weigh more and are closer to reality than measures standardized and imposed in a formal comparative protocol. The parallel work in Ecuador on the incoherence and irrelevance for Latin America of protocols recommended by international groups based on E.U.…”

Observational stepped-wedge analysis of a community health worker-led intervention for diabetes and hypertension in rural Mexico

“…Observational studies of CHW-led interventions demonstrated improvement in fasting plasma glucose,8 9 though a recent cluster-randomised trial found inconclusive results, potentially due to a lack of power 10. For cardiovascular disease, two systematic reviews, including one meta-analysis of randomised trials, identified improvements in blood pressure with CHW interventions 4 11. Several recent cluster-randomised trials around the world demonstrated blood pressure reduction and improved cardiovascular risk control among patients with uncontrolled hypertension 10 12–15.…”