A cluster‐randomized study on the Risk Assessment and Management Program for home blood pressure monitoring in an older population with inadequate health literacy

Fu, Sau Nga; M, Dao; Luk, Wan; Lam, Margaret Choi Hing; Ho, Irene; Cheung, Siu Keung; Wong, Carlos King Ho; Cheung, Bernard Man Yung

doi:10.1111/jch.13987

Cited by 8 publications

(6 citation statements)

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“…The add-on nurse-led risk assessment and intervention sessions contributed further through patient empowerment on self-care, including self-BP monitoring, smoking cessation, dietary modifications, physical activity, medication adherence and help-seeking behavior. 11 , 31 The potential contribution of these interventions might be proxied from the greater likelihood for RAMP-HT participants to be nonsmokers, and have all 5 CVD risks being at or below target values after 5 years. The strategic risk-stratified management also allowed for better care coordination and resource allocation.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention

Wan

Mak

et al. 2023

JAMA Netw Open

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ImportanceThere is a lack of information regarding the impact of implementing a protocol-driven, team-based, multicomponent intervention in public primary care settings on hypertension-related complications and health care burden over the long term.ObjectiveTo compare hypertension-related complications and health service use at 5 years among patients managed with Risk Assessment and Management Program for Hypertension (RAMP-HT) vs usual care.Design, Setting, and ParticipantsIn this population-based prospective matched cohort study, patients were followed up until the date of all-cause mortality, an outcome event, or last follow-up appointment before October 2017, whichever occurred first. Participants included 212 707 adults with uncomplicated hypertension managed at 73 public general outpatient clinics in Hong Kong between 2011 and 2013. RAMP-HT participants were matched to patients receiving usual care using propensity score fine stratification weightings. Statistical analysis was conducted from January 2019 to March 2023.InterventionsNurse-led risk assessment linked to electronic action reminder system, nurse intervention, and specialist consultation (as necessary), in addition to usual care.Main Outcomes and MeasuresHypertension-related complications (cardiovascular diseases, end-stage kidney disease), all-cause mortality, public health service use (overnight hospitalization, attendances at accident and emergency department, specialist outpatient clinic, and general outpatient clinic).ResultsA total of 108 045 RAMP-HT participants (mean [SD] age: 66.3 [12.3] years; 62 277 [57.6%] female) and 104 662 patients receiving usual care (mean [SD] age 66.3 [13.5] years; 60 497 [57.8%] female) were included. After a median (IQR) follow-up of 5.4 (4.5-5.8) years, RAMP-HT participants had 8.0% absolute risk reduction in cardiovascular diseases, 1.6% absolute risk reduction in end-stage kidney disease, and 10.0% absolute risk reduction in all-cause mortality. After adjusting for baseline covariates, the RAMP-HT group was associated with lower risk of cardiovascular diseases (hazard ratio [HR], 0.62; 95% CI, 0.61-0.64), end-stage kidney disease (HR, 0.54; 95% CI, 0.50-0.59), and all-cause mortality (HR, 0.52; 95% CI, 0.50-0.54) compared with the usual care group. The number needed to treat to prevent 1 cardiovascular disease event, end-stage kidney disease, and all-cause mortality was 16, 106, and 17, respectively. RAMP-HT participants had lower hospital-based health service use (incidence rate ratios ranging from 0.60 to 0.87) but more general outpatient clinic attendances (IRR, 1.06; 95% CI, 1.06-1.06) compared with usual care patients.Conclusions and RelevanceIn this prospective matched cohort study involving 212 707 primary care patients with hypertension, participation in RAMP-HT was associated with statistically significant reductions in all-cause mortality, hypertension-related complications, and hospital-based health service use after 5 years.

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Section: Discussionmentioning

confidence: 99%

Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention

Wan

Mak

et al. 2023

JAMA Netw Open

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“…Additionally, a previous survey using the Nutrition Literacy Assessment Instrument scale showed that BMI was associated with nutrition literacy and dietary habits [ 68 ]. Compared with people in the Risk Assessment and Management Program (RAMP) in a cluster-randomized survey, BMI showed no significant changes and a significantly higher BP control rate [ 69 ]. Obesity is often associated with salt-sensitive hypertension [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Development of a short-form Chinese health literacy scale for low salt consumption (CHLSalt-22) and its validation among hypertensive patients

Zhang

et al. 2022

BMC Nutr

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Background With the accelerated pace of people’s life and the changing dietary patterns, the number of chronic diseases is increasing and occurring at a younger age in today’s society. The speedily rising hypertensive patients have become one of the main risk factors for chronic diseases. People should focus on health literacy related to salt consumption and reach a better quality of life. Currently, there is a lack of local assessment tools for low salt consumption in mainland China. Objective To develop a short-form version of the Chinese Health Literacy Scale For Low Salt Consumption instrument for use in mainland China. Methods A cross-sectional design was conducted on a sample of 1472 people in Liaoxi, China. Participants completed a sociodemographic questionnaire, the Chinese version of the CHLSalt-22, the measuring change in restriction of salt (sodium) in the diet in hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS) to test the hypothesis. Exploratory factor analysis and confirmatory factor analyses were performed to examine the underlying factor structure of the CHLSalt-22. One month later, 37 patients who participated in the first test were recruited to evaluate the test-retest reliability. Results The CHLSalt-22 demonstrated adequate internal consistency, good test-retest reliability, satisfactory construct validity, convergent validity and discriminant validity. The CHLSalt-22 count scores were correlated with age, sex, body mass index (BMI), education level, income, occupation, the Measuring Change in Restriction of Salt (sodium) in Diet in Hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS). Conclusion The results indicate that the Chinese Health Literacy Scale For Low Salt Consumption (CHLSalt-22) version has good reliability and validity and can be considered a tool to assess health literacy related to salt consumption in health screenings.

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“…Additionally, a previous survey using the Nutrition Literacy Assessment Instrument scale showed that BMI was associated with nutrition literacy and dietary habits [70]. Compared with people in the Risk Assessment and Management Program (RAMP) in a cluster-randomized survey, BMI showed no signi cant changes and there was a signi cantly higher BP control rate [71]. Obesity is often associated with salt-sensitive hypertension [72].…”

Section: Discussionmentioning

confidence: 99%

Development of a short-form Chinese Health Literacy Scale For Low Salt Consumption (CHLSalt-22) and its validation among hypertensive patients

Zhang

et al. 2022

Preprint

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Background:With the accelerated pace of people's life and the changed dietary patterns, the number of chronic diseases is increasing and occurring at a younger age in today's society. The speedily rising patients with hypertension led it to becoming one of the main risk factors for chronic diseases. People should focus on health literacy related to salt consumption and reach a better quality of life. At present, there is a lack of local assessment tools for low salt consumption in mainland China. Objective:To develop a short-form version of Chinese Health Literacy Scale For Low Salt Consumption instrument for using in mainland China. Methods:A cross-sectional design was conducted in a sample of 1472 people in Liaoxi, China. Participants completed a sociodemographic questionnaire, the Chinese version of the CHLSalt-22, the measuring change in restriction of salt (sodium) in diet in hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ) and the Benefit-Finding Scales (BFS) to test the hypothesis. Exploratory factor analysis and confirmatory factor analyses were performed to examine the underlying factor structure of the CHLSalt-22. One month later, 37 patients who participated in the first test were recruited to evaluate the test–retest reliability. Results:The CHLSalt-22 demonstrated adequate internal consistency, good test–retest reliability and satisfactory construct validity, convergent validity and discriminant validity. The CHLSalt-22 count scores were correlated with age, sex, body mass index (BMI), education level, income, occupation, the Measuring Change in Restriction of Salt (sodium) in Diet in Hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS). Conclusion:The results indicate that the version of the Chinese Health Literacy Scale For Low Salt Consumption (CHLSalt-22) has good reliability and validity, and that it can be considered a tool to assess health literacy related to salt consumption in health screenings.

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A cluster‐randomized study on the Risk Assessment and Management Program for home blood pressure monitoring in an older population with inadequate health literacy

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 8 publications

References 37 publications

Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention

Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention

Development of a short-form Chinese health literacy scale for low salt consumption (CHLSalt-22) and its validation among hypertensive patients

Development of a short-form Chinese Health Literacy Scale For Low Salt Consumption (CHLSalt-22) and its validation among hypertensive patients

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