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Landscape of team-based care to manage hypertension: results from two surveys in low/middle-income countries

Oluwabunmi Ogungbe, Danielle Cazabon, Andrew E Moran, Dinesh Neupane, Cheryl Dennison Himmelfarb, Anbrasi Edward, George W Pariyo, Lawrence J Appel, Kunihiro Matsushita, Zhang Hongwei, Liu Tong, Girma A Dessie, Addisu Worku, Sohel Reza Choudhury, Shamim Jubayer, Mahfuzur Rahman Bhuiyan10, Shahinul Islam, Kufor Osi, Joseph Odu, Emmanuel Chijioke Obagha, et al.
BMJ Open

Objectives Team-based care is essential for improving hypertension outcomes in low-resource settings. We assessed perceptions of country representatives and healthcare workers (HCWs) on team-based hypertension care in low/middle-income countries.

Design Two cross-sectional surveys.

Setting The first survey (Country Profile Survey) was conducted in 17 countries and eight in-country regions: Algeria, Bangladesh, Burundi, Chile, China (Beijing, Henan, Shandong), Cuba, Ethiopia, India (Kerala, Madhya Pradesh, Maharashtra, Punjab, Telangana), Nepal, Nigeria, Philippines, Saint Lucia, Sri Lanka, Thailand, Turkey, Uganda and Vietnam. The second survey (HCW Survey) was conducted in four countries: Bangladesh, China, Ethiopia and Nigeria.

Participants Using convenience sampling, participants for the Country Profile Survey were representatives from 17 countries and eight in-country regions, and the HCW Survey was administered to HCWs in Bangladesh, China, Ethiopia and Nigeria.

Outcome measures Country-level use of team-based hypertension care framework, comprising administrative, basic and advanced clinical tasks. Current practices of different HCW cadres, perspectives on team-based management of hypertension, barriers and facilitators.

Results In the Country Profile Survey, all (23/23, 100%) countries/regions surveyed integrated team-based care for basic clinical hypertension management tasks, less for advanced tasks (7/23, 30%). In the HCW Survey, 854 HCWs participated, 47% of whom worked in rural settings. Most HCWs in the sample acknowledged the value of team-based hypertension care. Although there were slight variations by country in the study sample, overall, barriers to team-based hypertension care were identified as inadequate training (83%); regulatory issues (76%); resistance by patients (56%), physicians (42%) and nurses (40%). Facilitators identified were use of treatment algorithms (94%), telehealth/m-health technology (92%) and adequate compensation for HCWs (80%).

Conclusions Our findings revealed key lessons for health systems and governments regarding team-based care implementation. Specifically, policies to facilitate additional training, optimise HCWs’ roles within care teams, use of hypertension treatment protocols and telehealth/m-health technology will be essential to promote team-based care.