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Determining the frequency and level of task-sharing for hypertension management in LMICs: A systematic review and

Oluwabunmi Ogungbe1, Danielle Cazabon2, Adefunke Ajenikoko2

  • 1Johns Hopkins University School of Nursing, Baltimore, MD, USA.

Eclinicalmedicine
|April 28, 2022
PubMed

Insights

Team-based care significantly lowers systolic blood pressure (BP) in low- and middle-income countries. The effectiveness of hypertension management varies with the complexity of tasks performed by healthcare teams.

Area of Science:

  • Cardiovascular Disease Research
  • Global Health Initiatives
  • Healthcare Management

Background:

  • Low- and middle-income countries (LMICs) face a high burden of cardiovascular disease (CVD).
  • Team-based care models enhance capacity for improving blood pressure (BP) control.
  • This review assesses the efficacy of team-based care for hypertension across varying levels of complexity.

Purpose of the Study:

  • To evaluate the effectiveness of team-based care in managing hypertension.
  • To compare the impact of different levels of task complexity within healthcare teams on BP control.
  • To synthesize evidence on task-sharing interventions for hypertension in LMICs.

Main Methods:

  • Searched PubMed, Embase, Cochrane, and CINAHL for relevant studies.
  • Categorized healthcare worker tasks into administrative (level 1), basic clinical (level 2), and advanced clinical (level 3).
  • Conducted a meta-analysis of randomized controlled trials using a random-effects model to assess BP reduction compared to usual care.

Main Results:

  • Included 43 randomized controlled trials (RCTs), with 12 from the updated search.
  • Team-based care resulted in a pooled mean systolic BP reduction of -4.6 mm Hg (95% CI: -5.8, -3.4) compared to usual care.
  • Reductions were consistent across complexity levels: -4.7 mm Hg for administrative/basic clinical tasks and -4.5 mm Hg for advanced clinical tasks. Pharmacists' involvement showed the greatest reduction (-7.3 mm Hg).

Conclusions:

  • Team-based hypertension care consistently lowers systolic BP compared to usual care.
  • The magnitude of BP reduction is influenced by the clinical training and roles of healthcare team members.
  • Task-sharing interventions in LMICs demonstrate significant potential for improving hypertension management.
Abstract

Keywords:
HypertensionLMICTeam-based care

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