Limits...
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

Attendance outcome by country.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4390559&req=5

Figure 0003: Attendance outcome by country.

Mentions: Overall 263 of 4,101 (6.4%) participants were referred. Of these 52 (19.8%) were urgent and 211 (80.2%) non-urgent referrals (Fig. 2). Amongst all the referrals, we were able to verify that 96 (36.5%) scheduled and attended a visit at the local clinic, of which 36 of 52 (69%) were by those given urgent referrals and 60 of 211 (28.4%) by those given non-urgent referrals (Fig. 3). Those with urgent referrals scheduled and attended a visit at the clinic at a greater level (69%) compared to those who were provided with a non-urgent referral (28%) (p<0.001; Pearson χ2=25.6; 1 df). Additionally, at all these verified visits, 69.4% of the urgently referred persons were likely to receive a diagnosis of HTN, compared to the 37% of non-urgently referred persons (p<0.008; Pearson χ2=7.1; 1 df). HTN was the only diagnosis received by all those confirmed to have attended referral visits and 100% of those diagnosed received a prescription for anti-hypertensive medication.


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)

Attendance outcome by country.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: Attendance outcome by country.
Mentions: Overall 263 of 4,101 (6.4%) participants were referred. Of these 52 (19.8%) were urgent and 211 (80.2%) non-urgent referrals (Fig. 2). Amongst all the referrals, we were able to verify that 96 (36.5%) scheduled and attended a visit at the local clinic, of which 36 of 52 (69%) were by those given urgent referrals and 60 of 211 (28.4%) by those given non-urgent referrals (Fig. 3). Those with urgent referrals scheduled and attended a visit at the clinic at a greater level (69%) compared to those who were provided with a non-urgent referral (28%) (p<0.001; Pearson χ2=25.6; 1 df). Additionally, at all these verified visits, 69.4% of the urgently referred persons were likely to receive a diagnosis of HTN, compared to the 37% of non-urgently referred persons (p<0.008; Pearson χ2=7.1; 1 df). HTN was the only diagnosis received by all those confirmed to have attended referral visits and 100% of those diagnosed received a prescription for anti-hypertensive medication.

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