Adaptation, implementation, and evaluation of the HEARTS technical package in primary health care settings in Jordan to improve the management of hypertension: a pilot study.

The majority of patients with hypertension in Jordan have uncontrolled blood pressure. This study aimed to adapt and implement the hypertension management protocol (a module in the HEARTS technical package) in health care centers in Jordan and evaluate its effectiveness on hypertension management and control. The hypertension management protocol was adapted and implemented in six health centers followed by training of the healthcare staff on the adapted protocol. Patients above 18 years old who attended health centers during the study period were recruited consecutively. The blood pressure of 852 patients was monitored over 4 months, using an individual patient treatment card. At the baseline visit, the proportion of patients with uncontrolled blood pressure was 71.5%. After 4 months of the implementation of the protocol, the proportion of patients with uncontrolled blood pressure decreased to 29.1%. Of all studied characteristics, age was the only significant predictor of achieving blood pressure control. Patients aged ≤50 had a higher rate of controlled blood pressure readings after 4 months of implementation of the protocol compared to patients older than 60 years (OR = 1.98, 95% CI: 1.07, 3.67; P value = 0.028). In conclusion, the implementation of the HEARTS hypertension management protocol has successfully achieved better control of the blood pressure of the enrolled patients after 4 months of implementation. To achieve better control of hypertension in the general population, integrating evidence-based strategies for hypertension control that are listed in the HEART technical package into routine care is strongly recommended.

The capacity of primary health care centers in Jordan to manage hypertension: areas for improvement.

The assessment of the capacity of Primary Health Care (PHC) settings for the management of hypertension is essential to identify areas for improving management outcomes. This study aimed to assess the capacity of PHC centers in Jordan to manage hypertension including the assessment of human resources, equipment, and infrastructure. All comprehensive PHC centers located in Irbid and Mafraq governorates in north of Jordan (n = 23) were assessed. An assessment tool from HEARTS Technical Package was adapted and used for assessment. All centers have general practitioners and half of the centers (n = 11, 47.8%) had at least one family doctor working full time. In only one center, all doctors, nurses, and other health workers were trained on the management of hypertension. All centers, except one, had at least one functional automatic blood pressure measuring devices (BPMDs). Almost two thirds of centers (43.5%) had no measuring tapes. ECG machines were present in all centers except two. One third (n = 8, 34.8%) of centers had no functional glucometers. The majority of health centres carry out the laboratory investigations. Educational materials on physical activity, hypertension, and diabetes were seen in four (17.4%) centers only. Necessary medications were always available in the majority of health centers. In conclusion, this assessment revealed many areas for improvement in human resources, equipment, infrastructures, and other resources, such as developing an updated guideline/protocol of hypertension management, training the PHC staff on these guidelines, providing PHC centers with the necessary equipment, and establishing e-registry to improve documentation of data.