Development and effect of a coordinated Community Health Worker (CHW) Intervention (C-CHW-I) model for the stroke survivors in Kerala, South India.

IF 2.2 3区医学 Q3 CLINICAL NEUROLOGY Cerebrovascular Diseases Pub Date : 2024-01-05 DOI:10.1159/000536077

P N Sylaja, Veena Babu, Sivasambath S, Feba Zechariah, Sivalekshmi Gireesan, Geethu Ganesan, Biju Soman, Gurpreet Singh, Jeemon Panniyamakal, Bipin Gopal

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Abstract

Introduction: Structured models for secondary prevention of stroke in community settings are scarce. We aimed to develop and evaluate a model for improving medication adherence and enhanced risk factor monitoring.

Methods: We developed a multimodal C-CHW-I model for stroke survivors. Following training, all patients received a minimum of three CHW home visits, and once in 3-month telephone-call and health education for six months by CHWs. Seven blocks from 16 blocks of the study area were randomised to additionally receive an SMS alert for six months to reinforce CHW involvement. The primary outcomes were medication adherence and risk factor monitoring, and the secondary outcome was risk factor control.

Results: The mean age of the study population was 64+12 years, 765(85%) had ischaemic stroke. In the overall study cohort receiving the CHW intervention, mean medication adherence significantly improved from 3.56(0.88) at baseline to 3.78(0.61) at 6 months; p<0.001. Overall risk factor monitoring improved from 42.7% to 49.7%, and mean (standard deviation) systolic blood pressure (SBP) significantly reduced from 138(21) mmHg to 132(15) mmHg at 6-months; p<0.001. In patients additionally receiving SMS-based intervention, a statistically significant improvement in medication adherence was seen at 3 months (3.76+0.64 versus 3.61+0.81; p=0.008) however no difference persisted at 6 months. The proportion of smokers and alcohol users reduced in both groups with a trend to greater reduction in the intervention group (smokers:5.9% versus 2.8% (p=0.446) and alcohol users: 1.6% versus 1.4%(p=0.474)). At six months, the SBP did not differ (SBP (132.1(16.2) in the SMS group versus 133.2(15.8) mmHg in the control group, p=0.409).

Conclusion: Our model improved medication adherence and risk factor monitoring of stroke survivors in community settings, and this can reduce stroke burden in the community.

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针对南印度喀拉拉邦中风幸存者的社区保健员（CHW）协调干预（C-CHW-I）模式的发展和效果。

导言：在社区环境中进行中风二级预防的结构化模式很少。我们的目标是开发和评估一种改善药物依从性和加强危险因素监测的模式：我们为中风幸存者开发了一种多模式的 C-CHW-I 模型。经过培训后，所有患者都接受了至少三次社区保健员家访，社区保健员每 3 个月进行一次电话回访，并在 6 个月内对患者进行健康教育。从研究区的 16 个街区中随机抽取了 7 个街区，在 6 个月内额外接收短信提醒，以加强社区保健员的参与。主要结果是坚持用药和风险因素监测，次要结果是风险因素控制：研究对象的平均年龄为 64+12 岁，765 人（85%）患有缺血性中风。在接受 CHW 干预的整个研究队列中，平均服药依从性从基线时的 3.56(0.88) 显著提高到了 6 个月时的 3.78(0.61); p结论：我们的模式改善了服药依从性，并提高了风险因素监测的效率：我们的模式改善了社区环境中中风幸存者的用药依从性和风险因素监测，这可以减轻社区中风负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cerebrovascular Diseases 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.