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Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa.

Levitt NS, Puoane T, Denman CA, Abrahams-Gessel S, Surka S, Mendoza C, Khanam M, Alam S, Gaziano TA - Glob Health Action (2015)

Bottom Line: We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa.Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system.The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.

View Article: PubMed Central - PubMed

Affiliation: Chronic Disease Initiative for Africa, Cape Town, South Africa.

ABSTRACT

Background: We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management.

Design: Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained.

Results: Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system.

Conclusions: The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.

No MeSH data available.


Related in: MedlinePlus

Overview of study participants.
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Figure 0001: Overview of study participants.

Mentions: Amongst the 4,383 community members who agreed to participate in this study, 247 were ineligible and 35 participants did not complete the screening process. As a result, 4,101 participants were eligible for screening or referral, of which 1,016 (24.8%) were men (range: 20.0% in Guatemala, to 28.9% in South Africa) and 3,077 (75.2%) were women (range: 71.1% in South Africa, to 80.0% in Guatemala). During screening, 52 (1.3%) were found to have an average systolic blood pressure >180 mmHg and were provided with a same-day, urgent referral letter for assessment at the nearest clinic. The remaining eligible participants (n=4,049) had a CVD risk score calculated by the CHWs and were stratified into one of five risk categories from low to high (Fig. 1). The distribution of the CVD risk was found to be: 77.4% low risk, 17.4% low to moderate risk, 3.7% with moderate risk, 1.1% moderate–high risk and 0.2% high risk. The risk distribution across sites was similar in all five risk categories. Participants who were at lowest risk for CVD (Risk Score from 0 to 20%) ranged from 93% (South Africa) to 97% (Mexico) of the eligible, screened population, with a mean of 95%. Those at moderate risk who were eligible for referral (Risk Score from 21 to 40%) ranged from 3% (Guatemala and Mexico) to 7% (South Africa), with a mean of 5%. The proportion of persons who were eligible for urgent referral by being at highest risk (Risk Score >40%) ranged from 0% (Guatemala) to 0.3% (South Africa).


Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa.

Levitt NS, Puoane T, Denman CA, Abrahams-Gessel S, Surka S, Mendoza C, Khanam M, Alam S, Gaziano TA - Glob Health Action (2015)

Overview of study participants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390559&req=5

Figure 0001: Overview of study participants.
Mentions: Amongst the 4,383 community members who agreed to participate in this study, 247 were ineligible and 35 participants did not complete the screening process. As a result, 4,101 participants were eligible for screening or referral, of which 1,016 (24.8%) were men (range: 20.0% in Guatemala, to 28.9% in South Africa) and 3,077 (75.2%) were women (range: 71.1% in South Africa, to 80.0% in Guatemala). During screening, 52 (1.3%) were found to have an average systolic blood pressure >180 mmHg and were provided with a same-day, urgent referral letter for assessment at the nearest clinic. The remaining eligible participants (n=4,049) had a CVD risk score calculated by the CHWs and were stratified into one of five risk categories from low to high (Fig. 1). The distribution of the CVD risk was found to be: 77.4% low risk, 17.4% low to moderate risk, 3.7% with moderate risk, 1.1% moderate–high risk and 0.2% high risk. The risk distribution across sites was similar in all five risk categories. Participants who were at lowest risk for CVD (Risk Score from 0 to 20%) ranged from 93% (South Africa) to 97% (Mexico) of the eligible, screened population, with a mean of 95%. Those at moderate risk who were eligible for referral (Risk Score from 21 to 40%) ranged from 3% (Guatemala and Mexico) to 7% (South Africa), with a mean of 5%. The proportion of persons who were eligible for urgent referral by being at highest risk (Risk Score >40%) ranged from 0% (Guatemala) to 0.3% (South Africa).

Bottom Line: We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa.Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system.The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.

View Article: PubMed Central - PubMed

Affiliation: Chronic Disease Initiative for Africa, Cape Town, South Africa.

ABSTRACT

Background: We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management.

Design: Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained.

Results: Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system.

Conclusions: The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.

No MeSH data available.


Related in: MedlinePlus