Non-physician health workers for improving adherence to medications and healthy lifestyle following acute coronary syndrome: 24-month follow-up study

Sharma, Krishna Kumar; Gupta, Rajeev; Mathur, Mukul; Natani, Vishnu; Lodha, Sailesh; Roy, Sanjeeb; Xavier, Denis

doi:10.1016/j.ihj.2016.03.027

Cited by 20 publications

(39 citation statements)

References 38 publications

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“…Our study showed a highly significant decrease in the heart rate, DBP and SBP in the test group compared to the control group. These findings were consistent with Sharma et al after 12 months of follow‐up. However, the difference between two groups in number of patients achieving goals for BP, HR, FBS, total cholesterol was not statistically significant, except for LDL.…”

Section: Discussionsupporting

confidence: 93%

“…In 2016, Sharma et al succeeded in showing that clinical pharmacist–provided services can result in significantly lower total cholesterol, triglyceride and LDL cholesterol. Also, Taveira et al found that clinical pharmacist interventions can effectively reduce LDL levels and HbA1c%.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of risk factors associated with coronary heart disease are controllable, which makes this disease one of the most preventable causes of death in the world. 39 In 2016, Sharma et al 40 succeeded in showing that clinical pharmacist-provided services can result in significantly lower total cholesterol, triglyceride and LDL cholesterol. Also, Taveira et al 41 found that clinical pharmacist interventions can effectively reduce LDL levels and HbA1c%.…”

Section: Variable Test (N = 20) Control (N = 20) P-valuementioning

confidence: 99%

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Management of pharmacotherapy‐related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit

Casper

Wakeel

Saleh

et al. 2019

Basic Clin Pharma Tox

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Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide and negatively impacts healthcare costs, productivity and quality of life. Polymorbidity and polypharmacy predispose ACS patients to medication discrepancies between cardiologist‐prescribed medication and drug use by the patient, drug‐related problems (DRPs) and inadequate drug adherence. This study aimed to evaluate the impact of clinical pharmacist–provided services on the outcome of ACS patients. This was a prospective, randomized, controlled study on ACS patients participating in a cardiac rehabilitation programme. Forty ACS patients were randomly assigned to either control group, who received standard medical care, or intervention group, who received standard medical care plus clinical pharmacist–provided services. Services included DRP management, clinical assessment and enforcing the patient education and adherence. For both groups, the following were assessed at baseline and after 3 months: DRPs, adherence (assessed by 8‐item Morisky Adherence Questionnaire), patient's knowledge (assessed by Coronary Artery Disease Questionnaire), 36‐Short Form Health Survey (SF‐36), heart rate, systolic and diastolic blood pressure, low‐density lipoprotein (LDL), total cholesterol (TC) and fasting blood glucose (FBG). After 3 months, there was a significant difference between the intervention and control groups in the per cent change of DRPs (median: −100 vs 5.882, P = 0.0001), patient's adherence score (median: 39.13 vs −14.58, P = 0.0001), knowledge score (median: 30.28 vs −5.196, P = 0.0001), SF‐36 scores, heart rate (mean: −10.04 vs 6.791, P = 0.0001), diastolic blood pressure (mean: −17.87 vs 10.45, P = 0.0001), systolic blood pressure (mean: −16.22 vs 4.751, P = 0.0001), LDL (median: −25.73 vs −0.2538, P = 0.0071), TC (median: −14.62 vs 4.123, P = 0.0005) and FBG (median: −11.42 vs 5.422, P = 0.0098). Clinical pharmacists can play an important role as part of a cardiac rehabilitation team through patient education and interventions to minimize DRPs.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Variable Test (N = 20) Control (N = 20) P-valuementioning

confidence: 99%

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Management of pharmacotherapy‐related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit

Casper

Wakeel

Saleh

et al. 2019

Basic Clin Pharma Tox

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“…There is a growing body of evidence that chronic diseases in LMICs can be well managed, especially at the primary care level, by mid-level practitioners (MLPs) [10,[12][13][14][15][16][17][18][19][20][21]. MLPs offer a feasible, affordable, and highquality alternative to traditionally physician-delivered care.…”

Section: Introductionmentioning

confidence: 99%

An integrated intervention for chronic care management in rural Nepal: protocol of a type 2 hybrid effectiveness-implementation study

Schwarz¹,

Dhungana

Kumar

et al. 2020

Trials

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Background: In Nepal, the burden of noncommunicable, chronic diseases is rapidly rising, and disproportionately affecting low and middle-income countries. Integrated interventions are essential in strengthening primary care systems and addressing the burden of multiple comorbidities. A growing body of literature supports the involvement of frontline providers, namely mid-level practitioners and community health workers, in chronic care management. Important operational questions remain, however, around the digital, training, and supervisory structures to support the implementation of effective, affordable, and equitable chronic care management programs. Methods: A 12-month, population-level, type 2 hybrid effectiveness-implementation study will be conducted in rural Nepal to evaluate an integrated noncommunicable disease care management intervention within Nepal's new municipal governance structure. The intervention will leverage the government's planned roll-out of the World Health Organization's Package of Essential Noncommunicable Disease Interventions (WHO-PEN) program in four municipalities in Nepal, with a study population of 80,000. The intervention will leverage both the WHO-PEN and its cardiovascular disease-specific technical guidelines (HEARTS), and will include three evidence-based components: noncommunicable disease care provision using mid-level practitioners and community health workers; digital clinical decision support tools to ensure delivery of evidence-based care; and training and digitally supported supervision of mid-level practitioners to provide motivational interviewing for modifiable risk factor optimization, with a focus on medication adherence, and tobacco and alcohol use. The study will evaluate effectiveness using a pre-post design with stepped implementation. The primary outcomes will be disease-specific, "at-goal" metrics of chronic care management; secondary outcomes will include alcohol and tobacco consumption levels.

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“…[10,11] There is a growing body of evidence that chronic diseases in LMICs can be well-managed, especially at the primary care level, by mid-level practitioners (MLPs). [10,[12][13][14][15][16][17][18][19][20][21] MLPs offer a feasible, affordable, and high-quality alternative to traditionally physician-delivered care. This can help to circumvent access barriers, thereby leading to fewer late-stage presentations and complications of otherwise manageable chronic conditions.…”

Section: Introductionmentioning

confidence: 99%

An integrated intervention for chronic care management in rural Nepal: a type 2 hybrid effectiveness-implementation study

Schwarz¹,

Dhungana

Kumar

et al. 2019

Preprint

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Background In Nepal, the burden of non-communicable, chronic diseases is rapidly rising, and disproportionately affecting low- and middle-income countries. Integrated interventions are essential in strengthening primary care systems and addressing the burden of multiple comorbidities. A growing body of literature supports the involvement of frontline providers, namely mid-level practitioners and community health workers, in chronic care management. Important operational questions remain, however, around the digital, training, and supervisory structures to support the implementation of effective, affordable, and equitable chronic care management programs. Methods A twelve-month, population-level, type 2 hybrid effectiveness-implementation study will be conducted in rural Nepal to evaluate an integrated non-communicable disease care management intervention within Nepal’s new municipal governance structure. The intervention will leverage the government’s planned roll-out of the World Health Organization’s Package of Essential Non-communicable disease interventions (WHO-PEN) program in four municipalities in Nepal, with a study population of 80,000. The intervention will leverage both the WHO-PEN and its cardiovascular disease specific technical guidelines, HEARTS, and include three evidence-based components: 1) non-communicable disease care provision using mid-level practitioners and community health workers; 2) digital clinical decision support tools to ensure delivery of evidence-based care; and 3) training and digitally-supported supervision of mid-level practitioners to provide motivational interviewing for modifiable risk factor optimization, with a focus on medication adherence, and tobacco and alcohol use. The study will evaluate effectiveness using a pre-post design with stepped implementation. The primary outcomes will be disease-specific, “at-goal” metrics of chronic care management; secondary outcomes will include alcohol and tobacco consumption levels. Discussion This is the first population-level, hybrid effectiveness-implementation study of an integrated chronic care management intervention in Nepal. As low- and middle-income countries plan for the Sustainable Development Goals and universal health coverage, the results of this pragmatic study will offer insights into policy and programmatic design for non-communicable disease care management in the future.

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Non-physician health workers for improving adherence to medications and healthy lifestyle following acute coronary syndrome: 24-month follow-up study

Abstract: NPHW-led educational intervention for 12 months improved adherence to evidence based medicines and healthy lifestyles. Efficacy continued for 24 months with attrition.

Cited by 20 publications

References 38 publications

Management of pharmacotherapy‐related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit

Management of pharmacotherapy‐related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit

An integrated intervention for chronic care management in rural Nepal: protocol of a type 2 hybrid effectiveness-implementation study

An integrated intervention for chronic care management in rural Nepal: a type 2 hybrid effectiveness-implementation study

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