N.New research by NYU Grossman School of Medicine and Moi University School of Medicine in Kenya found that considering and incorporating social determinants of health – such as poverty and social isolation – into clinical management of blood pressure in Kenya May improve outcomes for patients who have diabetes or high blood pressure.
The study, recently published online in the Journal of the American College of Cardiology, found that patients who received a multi-component intervention that combined community microfinance groups with medical group visits after a year – patients with similar medical conditions met with a clinician and community health workers – had 44 percent greater reductions in systolic blood pressure (SBP) compared to patients receiving standard treatment for high blood pressure or diabetes.
While cardiovascular diseases remain the leading cause of death worldwide, the combined intervention proved to be particularly beneficial for patients with uncontrolled hypertension at the start of the study. According to the researchers, group visits can also have benefits beyond the health consequences, such as: B. combating social isolation, strengthening social cohesion and improving trust between clinicians and patients.
“We know that health outcomes largely depend on the conditions in which people are born, live and work, as well as numerous other socio-economic factors. The patient population in our study faced significant financial barriers to accessing care, ranging from inadequate health insurance to transportation costs, lost work time and a myriad of other challenges, ”says senior author Rajesh Vedanthan, MD, MPH, cardiologist and director of the department for global health in the Department of Population Health at NYU Langone.
According to Dr. Vedanthan’s approach of combining microfinance and group doctor visits can serve as a model for analog programs in the US that attempt to integrate social determinants of health into service delivery. The challenges facing the people of Kenya – financial stress, unemployment, housing instability, and food insecurity – are experienced by many communities across the United States.
“While the exact form of implementation has to adapt to the local context, there are clearly people in the US who are struggling with poverty, unemployment, racial discrimination and housing problems and who can benefit from a similar approach,” says Dr. Vedanthan.
How the study was conducted
The protocol for the study, known as BIGPIC: Bridging Income Generation with Group Integrated Care, was developed by Dr. Vedanthan and colleagues at AMPATH Kenya, a partnership between Moi University, Moi Teaching and Referral Hospital, and North American universities led by Indiana University.
The research team included 2,890 patients with diabetes or high blood pressure in western Kenya in four subgroups. The first group received standard AMPATH Chronic Disease Treatment, which is a multi-component, facility-based care consisting of one-on-one visits to a doctor and medication management. The second group received the usual support in combination with microfinance initiatives, such as the creation of municipal savings groups to pool emergency savings and provide interest-bearing loans for group members in financial need. The third group received group visits, where participants met monthly with a community health worker, clinician, and other patients with similar health problems. The fourth received a combination of group doctor visits and microfinance interventions. The researchers collected data from participants at the start of the study and after 3 and 12 months.
Financial hardship was a common thread for the majority of the participants. Almost two-thirds were unemployed, more than 75 percent had an international wealth index of less than 40 (an indicator of poverty), and less than 17 percent were enrolled in Kenya’s national health insurance.
Study results
After 12 months, 40 percent of the study participants achieved a blood pressure control. The largest results were seen with patients in the microfinance and group visits areas of the study. The group that received combined microfinance and group visits saw 44 percent greater blood pressure reductions than the group that received standard center-based care. Overall, women (who made up 69.9 percent of the study participants) had greater reductions in SBP than men, as did younger people compared to older people. Those who actively participated in the microfinance group’s integrated medical visiting groups achieved greater SBP reductions.
Dr. Vedanthan hopes the results will reveal similar strategies for combating other chronic diseases around the world, including in the United States.
In addition to Dr. Vedanthan are other co-authors Jemima H. Kamamo, MMed, Diana Menya, MBChB and Violet Naanyu, PhD, Moi University in Eldoret, Kenya; Richard Mugo, ScM, Benjamin Andama, Cleophas W. Chesoli, MA, Simon Manyara, BPharm and Vitalis Orango, BS, AMPATH Kenya; Valentin Fuster, MD, and Carol R. Horowitz, MD, Icahn School of Medicine on Mount Sinai; Joseph W. Hogan, ScD, Stavroula A. Chrysanthopoulou, PhD, and Allison K. DeLong, MS, Brown University; Gerald S. Bloomfield, David Edelman, and Eric A. Finkelstein, Duke University; Sonak D. Pastakia, PhD, Purdue University; and Thomas W. Valente, PhD, University of Southern California, Los Angeles. The study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health under grant number R01HL125487.
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Sasha Walek
Phone: 646-501-3873
sasha.walek@nyulangone.org
