Developing an Integrated System Approach for the Management of Hypertension: A Pilot Study

NCT ID: NCT02186067

Last Updated: 2015-06-25

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 118 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-02-28
• Study Completion Date: 2015-03-31

Brief Summary

Hypertension has become a public health concern worldwide due to its significant contribution to the global health burden and its role as a prominent risk factor for the development of a number of chronic diseases such as Cardiovascular diseases (CVD), the leading cause of mortality in Pakistan and Worldwide. According to WHO, about 7.5 million deaths worldwide is attributable to hypertension i.e. about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS.

Studies suggest that hypertension is among the top five most common presenting complaints to private general practice clinics. Therefore, primary care physicians/Family physicians are the first line service providers and; thus it is important to manage hypertensive patients early, through lifestyle and treatment interventions that may prevent the complications such as development of CVDs etc.

Detailed Description

To the best of authors' knowledge limited evidence is available from Pakistan on management of hypertension through an integrated approach. Therefore, the aim of the trial is to develop a health delivery system that effectively manages hypertension at primary care level.

Hypothesis: The development of an integrated management approach will be effective in managing hypertension at all levels among hypertensive patients.

Conditions

Hypertension

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Referral System

Referral System:

Primary Level Secondary Level Tertiary Level

Group Type: EXPERIMENTAL

Referral System

Intervention Type: OTHER

Primary Level:

Refer patients to secondary care centre if Patients has complicated hypertension (Patients with target organ damage, CVD, CKD or more the 3 drugs)

Secondary Level:

Community health center at Aga Khan University will serve as the secondary care center.

Family physician will manage patients with CVD, CKD or more than 3 drugs.

Tertiary care:

Cardiologist at the Aga Khan University will manage secondary, resistant and difficult to treat hypertension.

Behavioral: Other Interventions CME session by Cardiologist/Consultant Family Physician : At start , and at two months Community screening by Family physicians at the primary care center (open house) once in three months Patient group education session. Once in three months

Control

Usual/routine care will be provided to the patients

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Referral System

Primary Level:

Refer patients to secondary care centre if Patients has complicated hypertension (Patients with target organ damage, CVD, CKD or more the 3 drugs)

Secondary Level:

Community health center at Aga Khan University will serve as the secondary care center.

Family physician will manage patients with CVD, CKD or more than 3 drugs.

Tertiary care:

Cardiologist at the Aga Khan University will manage secondary, resistant and difficult to treat hypertension.

Behavioral: Other Interventions CME session by Cardiologist/Consultant Family Physician : At start , and at two months Community screening by Family physicians at the primary care center (open house) once in three months Patient group education session. Once in three months

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Individuals aged 40 years or over visiting the selected IMS centre with known hypertension or with consistently elevated BP on two separate visits (mean of last two of three measurements of systolic pressure ≥140 mm Hg or mean diastolic pressure ≥90 mm Hg) or already receiving treatment will be eligible for inclusion in the study.

Exclusion Criteria

• Those patients who require intensive care unit or coronary care unit admissions, or are diagnosed to have cognitive impairment, are agitated due to severe pain, non-resident of Karachi, or having language barrier will be excluded from the study.
• A screening form will be designed for the collection of the above mentioned information. The rationale of excluding all the participants with above mentioned condition is that the participants having these health concerns will either not be able to respond to our questionnaire or their presence may confound our results.

• Minimum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Aga Khan University

OTHER

Sponsor Role: lead

Responsible Party

Waris Qidwai

Professor and Chairman Department of Family Medicine

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Waris Qidwai

Role: PRINCIPAL_INVESTIGATOR

Aga Khan University

Locations

The Integrated Medical Services Clinics (IMS)

Karachi, Sindh, Pakistan

Countries

Pakistan

Other Identifiers

13102013FM

Identifier Type: -

Identifier Source: org_study_id