Reach and effectiveness of a HEARTS hypertension pilot project in Guatemala
The World Health Organization Global Hearts initiative (HEARTS) and technical package aim to improve the primary health care management of hypertension and other risk factors for cardiovascular disease at the population level. This study describes the first HEARTS implementation pilot project in Gua...
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Pan American Health Organization
2024-10-01
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| Series: | Revista Panamericana de Salud Pública |
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| Online Access: | https://iris.paho.org/handle/10665.2/61827 |
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| author | Irmgardt Alicia Wellmann José Javier Rodríguez Benilda Batzin Guillermo Hegel Luis Fernando Ayala Kim Ozano Meredith P. Fort Walter Flores Lesly Ramirez Eduardo Palacios Mayron Martínez Manuel Ramirez-Zea David Flood |
| author_facet | Irmgardt Alicia Wellmann José Javier Rodríguez Benilda Batzin Guillermo Hegel Luis Fernando Ayala Kim Ozano Meredith P. Fort Walter Flores Lesly Ramirez Eduardo Palacios Mayron Martínez Manuel Ramirez-Zea David Flood |
| author_sort | Irmgardt Alicia Wellmann |
| collection | DOAJ |
| description | The World Health Organization Global Hearts initiative (HEARTS) and technical package aim to improve the primary health care management of hypertension and other risk factors for cardiovascular disease at the population level. This study describes the first HEARTS implementation pilot project in Guatemala’s Ministry of Health (MOH) primary health care system. This pilot began in April 2022 in six primary health care facilities in three rural indigenous municipalities. The project consisted of HEARTS-aligned strategies adapted to enhance program sustainability in Guatemala. Outcomes were defined using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The primary reach outcome was treatment count, defined as the absolute number of patients per month receiving medication treatment for hypertension. The primary effectiveness outcomes were mean systolic blood pressure (BP), mean diastolic BP, and proportion of patients with BP control (<130/80 mmHg). In the first month of the post-implementation period, there was a statistically significant increase of 25 patients treated per month above the baseline of 20 to 25 patients (P = .002), followed by a significant increase of 2.4 additional patients treated each month (P = .005) thereafter. The mean change in systolic BP was −4.4 (95% CI, −8.2 to −0.5; P = 0.028) mmHg, and the mean change in diastolic BP was −0.9 (95% CI, −2.8 to 1.1; P = .376) mmHg. The proportion of the cohort with BP control increased from 33.4% at baseline to 47.1% at 6 months (adjusted change, 13.7%; 95% CI, 2.2% to 25.2%; P = .027). These findings support the feasibility of implementing the HEARTS model for BP control throughout the MOH primary health care system, which is where most Guatemalans with hypertension seek care. |
| format | Article |
| id | doaj-art-8e706c10cdec495f9bb07a60d8f3bf27 |
| institution | OA Journals |
| issn | 1020-4989 1680-5348 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Pan American Health Organization |
| record_format | Article |
| series | Revista Panamericana de Salud Pública |
| spelling | doaj-art-8e706c10cdec495f9bb07a60d8f3bf272025-08-20T01:48:04ZengPan American Health OrganizationRevista Panamericana de Salud Pública1020-49891680-53482024-10-01481001610.26633/RPSP.2024.100rpspReach and effectiveness of a HEARTS hypertension pilot project in GuatemalaIrmgardt Alicia Wellmann0José Javier Rodríguez1Benilda Batzin2Guillermo Hegel3Luis Fernando Ayala4Kim Ozano5Meredith P. Fort6Walter Flores7Lesly Ramirez8Eduardo Palacios9Mayron Martínez10Manuel Ramirez-Zea11David Flood12Institute of Nutrition of Central America and Panama, Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.Institute of Nutrition of Central America and Panama, Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.Center for the Study of Equity and Governance in Health Systems, Guatemala City, GuatemalaInstitute of Nutrition of Central America and Panama, Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.Institute of Nutrition of Central America and Panama, Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.Liverpool School of Tropical Medicine, Liverpool, United KingdomColorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of AmericaCenter for the Study of Equity and Governance in Health Systems, Guatemala City, GuatemalaCenter for the Study of Equity and Governance in Health Systems, Guatemala City, GuatemalaNational Program for the Prevention of Chronic Noncommunicable Diseases and Cancer, Ministry of Public Health and Social Assistance, Guatemala City, GuatemalaMinistry of Public Health and Social Assistance, Sololá, GuatemalaInstitute of Nutrition of Central America and Panama, Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.Institute of Nutrition of Central America and Panama, Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.The World Health Organization Global Hearts initiative (HEARTS) and technical package aim to improve the primary health care management of hypertension and other risk factors for cardiovascular disease at the population level. This study describes the first HEARTS implementation pilot project in Guatemala’s Ministry of Health (MOH) primary health care system. This pilot began in April 2022 in six primary health care facilities in three rural indigenous municipalities. The project consisted of HEARTS-aligned strategies adapted to enhance program sustainability in Guatemala. Outcomes were defined using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The primary reach outcome was treatment count, defined as the absolute number of patients per month receiving medication treatment for hypertension. The primary effectiveness outcomes were mean systolic blood pressure (BP), mean diastolic BP, and proportion of patients with BP control (<130/80 mmHg). In the first month of the post-implementation period, there was a statistically significant increase of 25 patients treated per month above the baseline of 20 to 25 patients (P = .002), followed by a significant increase of 2.4 additional patients treated each month (P = .005) thereafter. The mean change in systolic BP was −4.4 (95% CI, −8.2 to −0.5; P = 0.028) mmHg, and the mean change in diastolic BP was −0.9 (95% CI, −2.8 to 1.1; P = .376) mmHg. The proportion of the cohort with BP control increased from 33.4% at baseline to 47.1% at 6 months (adjusted change, 13.7%; 95% CI, 2.2% to 25.2%; P = .027). These findings support the feasibility of implementing the HEARTS model for BP control throughout the MOH primary health care system, which is where most Guatemalans with hypertension seek care.https://iris.paho.org/handle/10665.2/61827hypertensionimplementation scienceglobal healthhealth policyguatemala |
| spellingShingle | Irmgardt Alicia Wellmann José Javier Rodríguez Benilda Batzin Guillermo Hegel Luis Fernando Ayala Kim Ozano Meredith P. Fort Walter Flores Lesly Ramirez Eduardo Palacios Mayron Martínez Manuel Ramirez-Zea David Flood Reach and effectiveness of a HEARTS hypertension pilot project in Guatemala Revista Panamericana de Salud Pública hypertension implementation science global health health policy guatemala |
| title | Reach and effectiveness of a HEARTS hypertension pilot project in Guatemala |
| title_full | Reach and effectiveness of a HEARTS hypertension pilot project in Guatemala |
| title_fullStr | Reach and effectiveness of a HEARTS hypertension pilot project in Guatemala |
| title_full_unstemmed | Reach and effectiveness of a HEARTS hypertension pilot project in Guatemala |
| title_short | Reach and effectiveness of a HEARTS hypertension pilot project in Guatemala |
| title_sort | reach and effectiveness of a hearts hypertension pilot project in guatemala |
| topic | hypertension implementation science global health health policy guatemala |
| url | https://iris.paho.org/handle/10665.2/61827 |
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