Group Medical Visit and Microfinance Intervention for Patients With Diabetes or Hypertension in Kenya

Rajesh Vedanthan, Jemima H. Kamano, Stavroula A. Chrysanthopoulou, Richard Mugo, Benjamin Andama, Gerald S. Bloomfield, Cleophas W. Chesoli, Allison K. DeLong, David Edelman, Eric A. Finkelstein, Carol R. Horowitz, Simon Manyara, Diana Menya, Violet Naanyu, Vitalis Orango, Sonak D. Pastakia, Thomas W. Valente, Joseph W. Hogan, Valentin Fuster

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Background: Incorporating social determinants of health into care delivery for chronic diseases is a priority. Objectives: The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. Methods: The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. Results: A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined −11.4, −14.8, −14.7, and −16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (−8.5 to 0.7), 3.3 mm Hg (−7.8 to 1.2), and 2.3 mm Hg (−7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. Conclusions: A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes.

Original languageEnglish
Pages (from-to)2007-2018
Number of pages12
JournalJournal of the American College of Cardiology
Volume77
Issue number16
DOIs
StatePublished - 27 Apr 2021

Keywords

  • Kenya
  • diabetes
  • group medical visits
  • hypertension
  • microfinance
  • social determinants of health

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