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Home Health Education and Physician Training to Improve Care for Patients With High Blood Pressure in a Developing Country FREE

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The summary below is from the full report titled “Community-Based Interventions to Promote Blood Pressure Control in a Developing Country. A Cluster Randomized Trial.” It is in the 3 November 2009 issue of Annals of Internal Medicine (volume 151, pages 593-601). The authors are T.H. Jafar, J. Hatcher, N. Poulter, M. Islam, S. Hashmi, Z. Qadri, R. Bux, A. Khan, F.H. Jafary, A. Hameed, A. Khan, S.H. Badruddin, and N. Chaturvedi.

Ann Intern Med. 2009;151(9):I-24. doi:10.7326/0003-4819-151-9-200911030-00001
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What is the problem and what is known about it so far?

Uncontrolled high blood pressure has become a major cause of sickness and death worldwide. Despite evidence of benefits of a healthy diet, exercise, and drug treatment, care for patients with high blood pressure remains poor in many areas of the world. Care of high blood pressure is particularly difficult in developing countries, where people are poor and do not have easy access to health care and physicians have few opportunities to update their knowledge.

Why did the researchers do this particular study?

To find out whether a program that educated local physicians and provided home health education for patients would lead to better blood pressure control than usual care for patients with high blood pressure who live in Karachi, Pakistan.

Who was studied?

1341 patients with high blood pressure who lived in 12 communities in Karachi, Pakistan.

How was the study done?

The researchers assigned each community at random to receive yearly education for local physicians about high blood pressure treatment, home visits by community workers every 3 months to educate patients about high blood pressure and its treatment, both interventions together, or usual care. The researchers followed patients for 2 years and measured change in blood pressure.

What did the researchers find?

Patients who lived in communities that received both physician education and home visits had more improvement in blood pressure than patients who lived in communities that got neither or just 1 of these programs.

What were the limitations of the study?

Almost a fifth of patients dropped out of the study before completion.

What are the implications of the study?

A program of yearly physician education plus home visits by trained community members can improve blood pressure control for patients living in financially challenged communities. More study is needed to see whether this program works in other developing countries or in disadvantaged communities within developed countries.





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