Task-shifting for cardiovascular risk factor management

Lessons from the Global Alliance for Chronic Diseases

Rohina Joshi, Amanda G. Thrift, Carter Smith, Devarsetty Praveen, Rajesh Vedanthan, Joyce Gyamfi, Jon David Schwalm, Felix Limbani, Adolfo Rubinstein, Gary Parker, Olugbenga Ogedegbe, Jacob Plange-Rhule, Michaela Riddell, Kavumpurathu Raman Thankappan Thankappan, Margaret Thorogood, Jane Goudge, Karen E. Yeates

Research output: Contribution to journalArticleResearchpeer-review

8 Citations (Scopus)

Abstract

Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on 'lessons learnt ' throughout the implementation process and 'design to implementation' changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.

Original languageEnglish
Article numbere001092
Number of pages8
JournalBMJ Global Health
Volume3
DOIs
Publication statusPublished - 1 Jan 2018

Cite this

Joshi, Rohina ; Thrift, Amanda G. ; Smith, Carter ; Praveen, Devarsetty ; Vedanthan, Rajesh ; Gyamfi, Joyce ; Schwalm, Jon David ; Limbani, Felix ; Rubinstein, Adolfo ; Parker, Gary ; Ogedegbe, Olugbenga ; Plange-Rhule, Jacob ; Riddell, Michaela ; Thankappan, Kavumpurathu Raman Thankappan ; Thorogood, Margaret ; Goudge, Jane ; Yeates, Karen E. / Task-shifting for cardiovascular risk factor management : Lessons from the Global Alliance for Chronic Diseases. In: BMJ Global Health. 2018 ; Vol. 3.
@article{7415b953ee6741b2ab56d7fea4dc8db5,
title = "Task-shifting for cardiovascular risk factor management: Lessons from the Global Alliance for Chronic Diseases",
abstract = "Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on 'lessons learnt ' throughout the implementation process and 'design to implementation' changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.",
author = "Rohina Joshi and Thrift, {Amanda G.} and Carter Smith and Devarsetty Praveen and Rajesh Vedanthan and Joyce Gyamfi and Schwalm, {Jon David} and Felix Limbani and Adolfo Rubinstein and Gary Parker and Olugbenga Ogedegbe and Jacob Plange-Rhule and Michaela Riddell and Thankappan, {Kavumpurathu Raman Thankappan} and Margaret Thorogood and Jane Goudge and Yeates, {Karen E.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1136/bmjgh-2018-001092",
language = "English",
volume = "3",
journal = "BMJ Global Health",
issn = "2059-7908",
publisher = "BMJ",

}

Joshi, R, Thrift, AG, Smith, C, Praveen, D, Vedanthan, R, Gyamfi, J, Schwalm, JD, Limbani, F, Rubinstein, A, Parker, G, Ogedegbe, O, Plange-Rhule, J, Riddell, M, Thankappan, KRT, Thorogood, M, Goudge, J & Yeates, KE 2018, 'Task-shifting for cardiovascular risk factor management: Lessons from the Global Alliance for Chronic Diseases', BMJ Global Health, vol. 3, e001092. https://doi.org/10.1136/bmjgh-2018-001092

Task-shifting for cardiovascular risk factor management : Lessons from the Global Alliance for Chronic Diseases. / Joshi, Rohina; Thrift, Amanda G.; Smith, Carter; Praveen, Devarsetty; Vedanthan, Rajesh; Gyamfi, Joyce; Schwalm, Jon David; Limbani, Felix; Rubinstein, Adolfo; Parker, Gary; Ogedegbe, Olugbenga; Plange-Rhule, Jacob; Riddell, Michaela; Thankappan, Kavumpurathu Raman Thankappan; Thorogood, Margaret; Goudge, Jane; Yeates, Karen E.

In: BMJ Global Health, Vol. 3, e001092, 01.01.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Task-shifting for cardiovascular risk factor management

T2 - Lessons from the Global Alliance for Chronic Diseases

AU - Joshi, Rohina

AU - Thrift, Amanda G.

AU - Smith, Carter

AU - Praveen, Devarsetty

AU - Vedanthan, Rajesh

AU - Gyamfi, Joyce

AU - Schwalm, Jon David

AU - Limbani, Felix

AU - Rubinstein, Adolfo

AU - Parker, Gary

AU - Ogedegbe, Olugbenga

AU - Plange-Rhule, Jacob

AU - Riddell, Michaela

AU - Thankappan, Kavumpurathu Raman Thankappan

AU - Thorogood, Margaret

AU - Goudge, Jane

AU - Yeates, Karen E.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on 'lessons learnt ' throughout the implementation process and 'design to implementation' changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.

AB - Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on 'lessons learnt ' throughout the implementation process and 'design to implementation' changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.

UR - http://www.scopus.com/inward/record.url?scp=85061783398&partnerID=8YFLogxK

U2 - 10.1136/bmjgh-2018-001092

DO - 10.1136/bmjgh-2018-001092

M3 - Article

VL - 3

JO - BMJ Global Health

JF - BMJ Global Health

SN - 2059-7908

M1 - e001092

ER -