Cluster randomized trial on integrated primary care strategies to reduce high blood pressure in rural communities in Sri Lanka: Report from the feasibility study

Abstract

INTRODUCTION: Hypertension is the leading cause of mortality worldwide. Control of Blood Pressure and Risk Attenuation (COBRA) trial conducted in Pakistan, demonstrated that the combined intervention of home health education (HHE) plus training general practitioners (GPs)was more effective for lowering blood pressure (BP) compared to usual care. OBJECTIVES: A feasibility study was conducted to adapt and integrate evidence-based strategies to control hypertension in the primary healthcare system in rural Sri Lanka. METHOD: Public Health Midwives (PHMs) in three Medical Officer of Health areas in Kurunegala district were trained on digital BP measurement and health education of hypertensive patients and their families PHMs screened household members above 40 years of age to identify individuals with hypertension. Socio-demographic data was collected and HHE was delivered as per training manual.PHMs referred probable patients to trained medical officers in the closest divisional hospital for further care and regular follow up. A referral loop was maintained by tracking the referred patients at the rural hospital by supervising PHM and medical officers. RESULTS: 142 hypertensive individuals were recruited and 129(90.8%) of them presented to the health care facility for follow up. At the end of follow up mean systolic blood pressure reduction of 13.8 mmHg (p-0.001) in those with poorly controlled BP (SBP≥160or DBP≥100 ) was demonstrated. CONCLUSIONS: It is feasible to implement this community-based strategy integrated to routine care for improving the management of hypertension in rural communities. Findings of this feasibility study will be fully evaluated in a large randomized controlled trial.