Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa

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dc.contributor.authorLevitt, Naomi S
dc.contributor.authorPuoane, Thandi
dc.contributor.authorDenman, Catalina A
dc.contributor.authorAbrahams-Gessel, Shafika
dc.contributor.authorSurka, Sam
dc.contributor.authorMendoza, Carlos
dc.contributor.authorKhanam, Masuma
dc.contributor.authorAlam, Sartaj
dc.contributor.authorGaziano, Thomas A
dc.date.accessioned2021-10-08T07:04:10Z
dc.date.available2021-10-08T07:04:10Z
dc.date.issued2015
dc.description.abstractBackgroundWe have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management.DesignPatient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained.ResultsThirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system.ConclusionsThe existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.
dc.identifier.apacitationLevitt, N. S., Puoane, T., Denman, C. A., Abrahams-Gessel, S., Surka, S., Mendoza, C., ... Gaziano, T. A. (2015). Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa. <i>Global Health Action</i>, 8(1), 26318 - 177. http://hdl.handle.net/11427/34443en_ZA
dc.identifier.chicagocitationLevitt, Naomi S, Thandi Puoane, Catalina A Denman, Shafika Abrahams-Gessel, Sam Surka, Carlos Mendoza, Masuma Khanam, Sartaj Alam, and Thomas A Gaziano "Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa." <i>Global Health Action</i> 8, 1. (2015): 26318 - 177. http://hdl.handle.net/11427/34443en_ZA
dc.identifier.citationLevitt, N.S., Puoane, T., Denman, C.A., Abrahams-Gessel, S., Surka, S., Mendoza, C., Khanam, M. & Alam, S. et al. 2015. Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa. <i>Global Health Action.</i> 8(1):26318 - 177. http://hdl.handle.net/11427/34443en_ZA
dc.identifier.issn1654-9716
dc.identifier.issn1654-9880
dc.identifier.ris TY - Journal Article AU - Levitt, Naomi S AU - Puoane, Thandi AU - Denman, Catalina A AU - Abrahams-Gessel, Shafika AU - Surka, Sam AU - Mendoza, Carlos AU - Khanam, Masuma AU - Alam, Sartaj AU - Gaziano, Thomas A AB - BackgroundWe have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management.DesignPatient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained.ResultsThirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system.ConclusionsThe existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment. DA - 2015 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Global Health Action LK - https://open.uct.ac.za PY - 2015 SM - 1654-9716 SM - 1654-9880 T1 - Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa TI - Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa UR - http://hdl.handle.net/11427/34443 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34443
dc.identifier.vancouvercitationLevitt NS, Puoane T, Denman CA, Abrahams-Gessel S, Surka S, Mendoza C, et al. Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa. Global Health Action. 2015;8(1):26318 - 177. http://hdl.handle.net/11427/34443.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceGlobal Health Action
dc.source.journalissue1
dc.source.journalvolume8
dc.source.pagination26318 - 177
dc.source.urihttps://dx.doi.org/10.3402/gha.v8.26318
dc.subject.otherBangladesh
dc.subject.otherGuatemala
dc.subject.otherMexico
dc.subject.otherSouth Africa
dc.subject.othercardiovascular risk assessment
dc.subject.othercommunity health workers
dc.subject.otherlow-middle income countries
dc.subject.otherreferral outcomes
dc.subject.otherBangladesh
dc.subject.otherCardiovascular Diseases
dc.subject.otherCommunity Health Workers
dc.subject.otherFemale
dc.subject.otherGuatemala
dc.subject.otherHumans
dc.subject.otherHypertension
dc.subject.otherMale
dc.subject.otherMexico
dc.subject.otherPatient Acceptance of Health Care
dc.subject.otherPoverty
dc.subject.otherProgram Evaluation
dc.subject.otherReferral and Consultation
dc.subject.otherRisk Assessment
dc.subject.otherSouth Africa
dc.titleReferral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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