A chronic disease management model of care (Empower Health) was launched in rural and urban areas of Ghana and Kenya in 2018. The goal was to improve disease awareness, reduce the burden of disease, and improve the clinical effectiveness and efficiency of managing hypertension. Leveraging the model, clinicians provide patients with tailored management plans. Patients accessed regular blood pressure checks at home, at the clinic, or at community-partner locations where they received real-time feedback. On the mobile application, clinicians viewed patient data, provided direct patient feedback, and wrote electronic prescriptions accessible through participating pharmacies. To date, 1266 patients had been enrolled in the "real-world" implementation cohort and followed for an average of 351 ± 133 days across 5 facilities. Average baseline systolic blood pressure (SBP) was 145 ± 21 mmHg in the overall cohort and 159 ± 16 mmHg in the subgroup with uncontrolled hypertension (n = 743) as defined by baseline SBP ≥ 140 mmHg. SBP decreased significantly through 12 months in both the overall cohort (-9.4 mmHg, p < .001) and in the uncontrolled subgroup (-17.6 mmHg, p < .001). The proportion patients with controlled pressure increased from 46% at baseline to 77% at 12 months (p < .001). In summary, a new chronic disease management model of care improved and sustained blood pressure control to 12 months, especially in those with elevated blood pressure at enrollment.

Improved blood pressure control via a novel chronic disease management model of care in sub-Saharan Africa: Real-world program implementation results.

Abstract Background Arterial hypertension (aHT) is the leading cardiovascular disease (CVD) risk factor in sub-Saharan Africa; it remains, however, underdiagnosed, and undertreated. Community-based care services could potentially expand access to aHT diagnosis and treatment in underserved communities. In this scoping review, we catalogued, described, and appraised community-based care models for aHT in sub-Saharan Africa, considering their acceptability, engagement in care and clinical outcomes. Additionally, we developed a framework to design and describe service delivery models for long-term aHT care. Methods We searched relevant references in Embase Elsevier, MEDLINE Ovid, CINAHL EBSCOhost and Scopus. Included studies described models where substantial care occurred outside a formal health facility and reported on acceptability, blood pressure (BP) control, engagement in care, or end-organ damage. We summarized the interventions’ characteristics, effectiveness, and evaluated the quality of included studies. Considering the common integrating elements of aHT care services, we conceptualized a general framework to guide the design of service models for aHT. Results We identified 18,695 records, screened 4,954 and included twelve studies. Four types of aHT care models were identified: services provided at community pharmacies, out-of-facility, household services, and aHT treatment groups. Two studies reported on acceptability, eleven on BP control, ten on engagement in care and one on end-organ damage. Most studies reported significant reductions in BP values and improved access to comprehensive CVDs services through task-sharing. Major reported shortcomings included high attrition rates and their nature as parallel, non-integrated models of care. The overall quality of the studies was low, with high risk of bias, and most of the studies did not include comparisons with routine facility-based care. Conclusions The overall quality of available evidence on community-based aHT care is low. Published models of care are very heterogeneous and available evidence is insufficient to recommend or refute further scale up in sub-Sahara Africa. We propose that future projects and studies implementing and assessing community-based models for aHT care are designed and described according to six building blocks: providers, target groups, components, location, time of service delivery, and their use of information systems. 

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Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: a literature scoping review and framework for designing chronic services

Rapid expansion of internet access and mobile technologies in low-and middle-income countries has accelerated interest in digital health strategies to improve cardiac surgery outcomes in resource-constrained areas. Several pilot studies of wearable and portable health monitoring devices, virtual reality, and telehealth platforms have shown great promise as governments strategically invest in information and communication technology expansion and costs continue to decline for internet-assisted devices. However, future research directions on digital health systems and interventions must focus on overcoming key challenges in achieving interoperability with existing health care infrastructures, ensuring coverage across diverse socio-economic regions, and user-centric design approaches that incorporate the local cultural context to increase adoption and usability.

Emerging Opportunities for Sustainable Digital Health Enhanced Care Delivery Models for Improved Cardiovascular Surgery Outcomes

Introduction: Our Whole Lives-Hypertension (OWL-H) is an eHealth toolkit for hypertension and cardiac risks factors. It is a hybrid online self-management platform that teaches blood pressure (BP) ...

A Teaching Kitchen Medical Groups Visit with an eHealth Platform for Hypertension and Cardiac Risk Factors: A Qualitative Feasibility Study

Abstract Background: Hypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores health system factors contributing to hypertension outcomes in SSA. Methods: The World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and June 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for risk of bias using the tools from Joanna Briggs Institute. Results: Thirty-nine studies clustered in 10 SSA countries met inclusion criteria. Health system determinants included human resource factors such as providers' knowledge and adherence to hypertension treatment guidelines (n=21) and task sharing and shifting strategies (n=10). The second health system factors explored in service delivery were the health facility type and capacity (n=7) and hypertension service accessibility by cost, place, and time of services (n=15). A quarter of the included studies explored supply chain management for access to essential equipment and medicines. An additional set of studies addressed quality improvement strategies involving cross-integration of services (n=7) and various strategies of gauging the systems for better hypertension outcomes (n=8). Conclusion: A combination of multiple rather than solo system interventions may yield significant improvements in blood pressure outcomes. Health information management and leadership involvement were less explored. Additional research on health system determinants of hypertension is needed to drive global improvements in hypertension outcomes. Future research would benefit from more rigorous implementation type interventional studies comprehensively assessing health system factors that contribute to better hypertension outcomes.

Health System Determinants of Hypertension Care and Outcomes in Sub-Saharan Africa: A Systematic Review

Isaac Kofi Owusu1, Fred Adomako-Boateng2, Fred Kueffer3, Molly Guy3, Chemuttaai Lang’at3, Daniel B Grossman4, Teri Whitman3, Keith Holloman3, Douglas A Hettrick3* and Opare-Sem O1 1Department of Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana 2Regional Health Directorate, Ghana Health Service, Kumasi, Ghana 3Medtronic, Inc, Minneapolis, MN, USA 4Mayo Clinic, Rochester, MN, USA

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Novel Hypertension Management Model of Care Improves Blood Pressure Control in a West African Population

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jch.14253

Response to: Cavagna et al The importance of considering cultural and environmental elements in an interventional model of care to fight hypertension in Africa.

Techniques for systems and methods for remotely monitoring a patient are provided. The system comprises a plurality of input sources operable to acquire patient-specific information corresponding to a condition of a patient. A patient-centric threshold is computed based on relevant environmental, cultural, societal, religion, and economic data for evaluation of the acquired physiological parameters. Risk stratification is performed to determine the risk level of the patient based on the patient-centric threshold, and a recommendation is generated. The recommendation includes a treatment/care plan that can consist of prescriptions and patient education tailored to the risk stratification and patient-specific information.

Molly Guy

Papers

Improved blood pressure control via a novel chronic disease management model of care in sub-Saharan Africa: Real-world program implementation results.

Novel Hypertension Management Model of Care Improves Blood Pressure Control in a West African Population

Response to: Cavagna et al The importance of considering cultural and environmental elements in an interventional model of care to fight hypertension in Africa.

Remote patient monitoring system