TY - JOUR
T1 - Group Medical Visit and Microfinance Intervention for Patients With Diabetes or Hypertension in Kenya
AU - Vedanthan, Rajesh
AU - Kamano, Jemima H.
AU - Chrysanthopoulou, Stavroula A.
AU - Mugo, Richard
AU - Andama, Benjamin
AU - Bloomfield, Gerald S.
AU - Chesoli, Cleophas W.
AU - DeLong, Allison K.
AU - Edelman, David
AU - Finkelstein, Eric A.
AU - Horowitz, Carol R.
AU - Manyara, Simon
AU - Menya, Diana
AU - Naanyu, Violet
AU - Orango, Vitalis
AU - Pastakia, Sonak D.
AU - Valente, Thomas W.
AU - Hogan, Joseph W.
AU - Fuster, Valentin
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/4/27
Y1 - 2021/4/27
N2 - 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.
AB - 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.
KW - Kenya
KW - diabetes
KW - group medical visits
KW - hypertension
KW - microfinance
KW - social determinants of health
UR - http://www.scopus.com/inward/record.url?scp=85104051236&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2021.03.002
DO - 10.1016/j.jacc.2021.03.002
M3 - Article
C2 - 33888251
AN - SCOPUS:85104051236
SN - 0735-1097
VL - 77
SP - 2007
EP - 2018
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 16
ER -