Rajesh Vedanthan1, Jemima H Kamano2, Stavroula A Chrysanthopoulou3, Richard Mugo4, Benjamin Andama4, Gerald S Bloomfield5, Cleophas W Chesoli4, Allison K DeLong3, David Edelman5, Eric A Finkelstein6, Carol R Horowitz7, Simon Manyara4, Diana Menya8, Violet Naanyu9, Vitalis Orango4, Sonak D Pastakia10, Thomas W Valente11, Joseph W Hogan3, Valentin Fuster7. 1. New York University Grossman School of Medicine, New York, New York, USA. Electronic address: rajesh.vedanthan@nyulangone.org. 2. School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya. 3. Brown University, Providence, Rhode Island, USA. 4. Academic Model Providing Access to Healthcare, Eldoret, Kenya. 5. Duke University, Durham, North Carolina, USA. 6. Duke University, Durham, North Carolina, USA; Duke-National University of Singapore Medical School, Singapore. 7. Icahn School of Medicine at Mount Sinai, New York, New York, USA. 8. School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya. 9. School of Arts and Social Sciences, Moi University, Eldoret, Kenya. 10. Purdue University, West Lafayette, Indiana, USA. 11. University of Southern California, Los Angeles, California, USA.
Abstract
BACKGROUND: Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES: The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS: The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. RESULTS: A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined -11.4, -14.8, -14.7, and -16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (-8.5 to 0.7), 3.3 mm Hg (-7.8 to 1.2), and 2.3 mm Hg (-7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. CONCLUSIONS: A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC]; NCT02501746).
BACKGROUND: Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES: The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS: The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. RESULTS: A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined -11.4, -14.8, -14.7, and -16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (-8.5 to 0.7), 3.3 mm Hg (-7.8 to 1.2), and 2.3 mm Hg (-7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. CONCLUSIONS: A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC]; NCT02501746).
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Authors: Samuel G Ruchman; Allison K Delong; Jemima H Kamano; Gerald S Bloomfield; Stavroula A Chrysanthopoulou; Valentin Fuster; Carol R Horowitz; Peninah Kiptoo; Winnie Matelong; Richard Mugo; Violet Naanyu; Vitalis Orango; Sonak D Pastakia; Thomas W Valente; Joseph W Hogan; Rajesh Vedanthan Journal: BMJ Open Date: 2021-09-02 Impact factor: 3.006
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