Nonphysician health workers can identify Indian villagers at CVD risk
MedWire News: Nonphysician health worker (NPHW)-led clinical interventions in Indian villages could increase the number of individuals identified as being at high risk for cardiovascular disease (CVD), a study suggests.
CVD is a major health problem in India and accounts for almost four million deaths - 30% of total deaths - per year, say Clara Chow (University of Sydney, Australia) and team in the Journal of the American College of Cardiology. Around 52% of CVD deaths occur in those younger than 70 years, compared with only 23% in developed countries.
They therefore conducted the cluster-randomized Rural Andhra Pradesh Cardiovascular Prevention Study to develop, implement, and evaluate two CVD-prevention strategies that could potentially be delivered by NPHWs in India: one based on health awareness promotion and the other on a clinical approach.
Chow et al studied 44 villages in the state of Andhra Pradesh. Consent for the study was obtained from the Panchayat of each village - a panel of village elders. Villages were eligible for the research if the Panchayat gave their agreement, there was a village health center, and a list of residents.
Each village was paired with another, with one from each pair randomly allocated to the intervention group and the other to the control group.
The clinical intervention was designed to increase the identification of people at high risk for CVD events (history of heart attack, stroke, angina) who would be eligible for proven preventive drug therapies.
For this, the researchers developed a simple hard copy algorithm to be used as a screening tool by the NPHWs. Practitioners were trained to ask all adults three simple questions about the occurrence of previous CVD. In the case of a positive response, a second review was conducted by a physician who then indicated whether drugs should be prescribed or not.
The primary objective of the health awareness intervention was to increase the knowledge of the adult population with regard to key health behaviors related to CVD.
The campaign included posters, street theater, rallies, and community presentations designed to stop tobacco use, promote heart-healthy eating, and physical activity.
In the villages using opportunistic screening, the proportion of high-risk individuals reporting that they were screened for CVD was 12% higher than in the control villages (63.5 vs 51.4%; p=0.026).
There was no detectable effect of the health promotion intervention on the primary outcome of knowledge about the factors affecting CVD risk, which "raises uncertainty about the effectiveness of the health promotion component," say the authors. However, individuals who received the health promotion intervention were significantly more likely to avoid consumption of oily foods (p=0.01).
"This trial provides clear evidence that NPHWs can be trained to reliably identify individuals at high CV risk with a simple algorithm and shows that they can use the tool to identify the correct preventive therapy in the majority of cases," write the authors.
They conclude that although additional work is required before a policy change to support widespread implementation can be considered, "these data provide a strong rationale for the further investigation of the role of NPHWs in the management of large chronic disease burden in India."
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By Piriya Mahendra