Cardiovascular disease risk management in a primary health care setting of north India.

ABSTRACT

OBJECTIVE: This study was primarily carried out to assess the feasibility of an adapted WHO CVD risk management package in a primary care setting. METHODS: A community intervention trial was conducted in eight health posts located in rural, urban, and slum areas of northern India. After a 4 day training, eight health workers implemented the package among 1010 adults > or =30 years of age from a randomly chosen cluster of households. Locally adapted scenario 1 WHO protocol was used for the assessment of CVD risks. The health workers inquired about smoking, alcohol, diet, physical activity, symptoms of angina, and transient ischaemic attacks; and measured systolic blood pressure (SBP7), height, and weight. Those with a risk were counseled and referred to a physician. Hypertensives were followed at 1, 3, and 5-month interval to reinforce risk prevention and adherence to treatment. In a 20% random sub sample, in the study and control area before and after the intervention, WHO STEPS instrument was used to evaluate effectiveness of the package. FINDINGS: After training, the knowledge of health workers regarding risk factors and symptoms of CVDs increased from 47% to 92.5%, and their performance in detection of risks was comparable to the investigator. All health workers could pay scheduled home visits regularly. They referred 279 (27.6%) individuals having raised systolic blood pressure (SBP), and 74.5% contacted the doctor. Significant decrease in mean SBP (8.8 mm Hg) was observed during follow-up. Significantly higher reports of intention to quit tobacco (60.3% vs 25.5%) and regular intake of anti-hypertensive medication (58.3% vs 34.8%) were observed in the intervention area compared to the control area. CONCLUSION: Adapted WHO CVD risk management package can be implemented through primary care system.