Adaptation, Implementation, and Evaluation of the HEARTS Technical Package in Primary Health Care Settings in Jordan to Improve the Management of Hypertension
- Cardiovascular Diseases
Background
The prevalence of hypertension is high in Jordan and is increasing. The majority of Jordanian patients on antihypertensive are uncontrolled. This study aimed to adapt and implement the HEARTS technical package in primary care centers and evaluate its effectiveness on hypertension management and control.
Methods
All physicians in 6 selected health centers in north of Jordan were trained on HEARTS technical package and guidelines for the management of hypertension. Patients over 18 years were recruited consecutively and the management of their hypertension was monitored over a 4-months period. Individual patient treatment cards were used to monitor blood pressure (BP) control, adherence to medication, follow-up examinations, investigations and complications. A minimum of four blood pressure readings, one month apart, were recorded each patient. Chi-square test and binary logistic regression were used to analyze data in SPSS.
Results
Overall, the BP of 852 patients was followed up. After 4 months of the implementation of the HEARTS protocol, the proportion of patients with uncontrolled BP had decreased form 71.5% at the baseline visit to 29.1%. Of the total 609 patients with uncontrolled BP at the baseline, 380 (62.4%) had controlled blood pressure readings after 4 months. Of all studied characteristics, age was the only significant predictor of achieving BP control. Patients aged ≤50 had higher rate of controlled BP compared to patients older than 60 years (OR = 1.98, 95% CI: 1.07, 3.67; P-value = 0.028).
Conclusion
The implementation of the HEARTS technical package has successfully achieved better control of the BP after 4 months of implementation. Therefore, scaling up HEARTS technical package is strongly recommended to integrate evidence-based strategies for hypertension control into routine care. However, it is important that such guidelines are supported by clinically relevant data through the establishment of an NCD registry in Jordan.
The prevalence of hypertension is high in Jordan and is increasing. The majority of Jordanian patients on antihypertensive are uncontrolled. This study aimed to adapt and implement the HEARTS technical package in primary care centers and evaluate its effectiveness on hypertension management and control.
Methods
All physicians in 6 selected health centers in north of Jordan were trained on HEARTS technical package and guidelines for the management of hypertension. Patients over 18 years were recruited consecutively and the management of their hypertension was monitored over a 4-months period. Individual patient treatment cards were used to monitor blood pressure (BP) control, adherence to medication, follow-up examinations, investigations and complications. A minimum of four blood pressure readings, one month apart, were recorded each patient. Chi-square test and binary logistic regression were used to analyze data in SPSS.
Results
Overall, the BP of 852 patients was followed up. After 4 months of the implementation of the HEARTS protocol, the proportion of patients with uncontrolled BP had decreased form 71.5% at the baseline visit to 29.1%. Of the total 609 patients with uncontrolled BP at the baseline, 380 (62.4%) had controlled blood pressure readings after 4 months. Of all studied characteristics, age was the only significant predictor of achieving BP control. Patients aged ≤50 had higher rate of controlled BP compared to patients older than 60 years (OR = 1.98, 95% CI: 1.07, 3.67; P-value = 0.028).
Conclusion
The implementation of the HEARTS technical package has successfully achieved better control of the BP after 4 months of implementation. Therefore, scaling up HEARTS technical package is strongly recommended to integrate evidence-based strategies for hypertension control into routine care. However, it is important that such guidelines are supported by clinically relevant data through the establishment of an NCD registry in Jordan.