title: The impact of a nurse-led care programme on events and physical and psychosocial parameters in patients with heart failure with preserved ejection fraction: A randomized clinical trial in primary care in Russia Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: a cluster-randomized trial. Community based lifestyle intervention for blood pressure reduction in children and young adults in developing country: cluster randomised controlled trial The Nigerian antihypertensive adherence trial: a community-based randomized trial Effects on diabetes management of a health-care provider mediated, remote coaching system via a PDA-type glucometer and the Internet The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial Nurse–Community Health Worker Team Improves Diabetes Care in American Samoa Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: a cluster-randomised trial. Nurse follow-up of patients with diabetes: randomized controlled trial. A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. Evaluation of a nurse-led disease management programme for chronic kidney disease: a randomized controlled trial. Effect of telephone follow-up on adherence to a diabetes therapeutic regimen. Adherence to diabetes control recommendations: impact of nurse telephone calls. Effects of a postdischarge transitional care programme for patients with coronary heart disease in China: a randomised controlled trial. The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours and BMI in a primary health care setting.
abstract: Abstract Background : Disease management programmes ( DMPs ) improve quality of care for patients with heart failure ( HF ) . However , only a limited number of trials have studied the efficacy of such programmes for patients with heart failure with preserved ejection fraction ( HFPEF ) . Objective : To estimate the impact of a structured , nurse-led patient education programme and care plan in general practice on outcome parameters and events in patients with HFPEF . Methods : Single blinded r and omized clinical trial with an intervention over six months and a follow-up during 12 additional months . In the control group , the patients ( n = 41 ) were managed according to Russian national guidelines . Patients in the intervention group ( n = 44 )  received education on individual lifestyle changes and modifications of cardiovascular disease ( CVD ) risk factors , home-based exercise training and weekly nurse consultations in addition to usual care . Results : Six months after their inclusion , patients in the intervention group significantly improved body mass index , waist circumference , six-min walk test distance , total cholesterol , low-density lipoprotein , left ventricular end-diastolic volume index , quality of life and level of anxiety . After 18 months , there were 11 deaths ( 25 % ) or hospitalizations in the intervention group and 12 ( 29 % ) in the control group ( P = 0.134 ) . Cardiovascular mortality and readmission rate were not reduced significantly after six months of follow-up : the hazard ratio was 0.47 ( 95 % CI : 0.17–1.28 ; P = 0.197 ) . After 18 months , this was 0.85 ( 0.42–1.73 ; P = 0.658 ) . Conclusion : This primary care based DMP for patients with HFPEF improved the patients ’ emotional status and quality of life , positively influenced body weight , functional capacity and lipid profile , and attenuated heart remodelling OBJECTIVE To evaluate a simple cardiovascular risk management package for assessing and managing cardiovascular risk using hypertension as an entry point in primary care facilities in low-re source setting s. METHODS Two geographically distant regions in two countries ( China and Nigeria ) were selected and 10 pairs of primary care facilities in each region were r and omly selected and matched . Regions were then r and omly assigned to a control group , which received usual care , or to an intervention group , which applied the cardiovascular risk management package . Each facility enrolled 60 consecutive patients with hypertension . Intervention sites educated patients about risk factors at baseline and initiated treatment with hydrochlorothiazide at 4 months in patients at medium risk of a cardiovascular event , according to a st and ardized treatment algorithm . Systolic blood pressure change from baseline to 12 months was the primary outcome measure . FINDINGS The study included 2397 patients with baseline hypertension : 1191 in 20 intervention facilities and 1206 in 20 control facilities .  Systolic and diastolic blood pressure decreased more in intervention patients than in controls . However , at 12 months more than half of patients still had uncontrolled hypertension ( systolic blood pressure > 140 mmHg and /or diastolic blood pressure > 90 mmHg ) . Behavioural risk factors had improved among intervention patients in Nigeria but not in China . Only about 2 % of hypertensive patients required referral to the next level of care . CONCLUSION Even in low-re source setting s , hypertensive patients can be effectively assessed and managed in primary care facilities Objective To assess the effectiveness of a community based lifestyle intervention on  blood pressure in children and young adults in a developing country setting . Design Cluster r and omised controlled trial . Setting 12 r and omly selected geographical census based clusters in Karachi , Pakistan . Participants 4023 people aged 5 - 39 years . Intervention Three monthly family based home health education delivered by lay health workers . Main outcome measure Change in blood pressure from r and omisation to end of follow-up at 2 years . Results Analysed using the intention to treat principle , the change in systolic blood pressure ( adjusted for age , sex , and baseline blood pressure ) was significant ; it increased by 1.5 ( 95 % confidence interval 1.1 to 1.9 ) mm Hg in the control group and by 0.1 ( −0.3 to 0.5 ) mm Hg in the home health education group ( P for difference between groups=0.02 ) . Findings for diastolic blood pressure were similar ; the change was 1.5 mm Hg greater in the control group than in the intervention group ( P=0.002 ) . Conclusions Simple , family based home health education delivered by trained lay health workers significantly ameliorated the usual increase in blood pressure with age in children and young adults in the general population of Pakistan , a low income developing country . This strategy is potentially feasible for up-scaling within the existing healthcare systems of Indo-Asia . Trial registration Clinical trials NCT00327574 Background : Research in industrialized countries has demonstrated that a key factor limiting the control of hypertension is poor patient adherence and that the most successful interventions for long-term adherence employ multiple strategies . Very little data exist on this question in low-income countries , wherein medication-taking behavior may be less well developed . Method : We conducted a treatment adherence trial of 544 patients [ mean age ∼63 years , mean blood pressure ( BP ) ∼168/92 mmHg ] with previously untreated hypertension in urban and rural Nigeria . Eligible participants were r and omized to one of two arms : clinic management only , or clinic management and home visits . Both interventions included three elements : a community based , nurse-led treatment program with physician backup ; facilitation of clinic visits and health education ; and the use of diuretics and a & bgr ; blocker as needed . After initial diagnosis , the management protocol was implemented by a nurse with physician backup . Participants were evaluated monthly for 6 months . Results : Medication adherence was assessed with pill count and urine testing . Drop-out rates , by treatment group , ranged from 12 to 28 % . Among participants who completed the 6-month trial , overall adherence was high ( ∼77 % of participants took > 98 % of prescribed pills ) . Adherence did not differ by treatment arm , but was better at the rural than the urban site and among those with higher baseline BP . Hypertension control ( BP < 140/90 mmHg ) was achieved in approximately 66 % of participants at 6 months . Conclusion : This community-based intervention confirms relatively modest default rates compared with industrialized societies , and suggests that medication adherence can be high in developing world setting s in clinic attenders We conducted a r and omized controlled trial for 12 weeks in patients with type 2 diabetes living in a rural part of Korea . The intervention group ( n = 35 ) was managed by a diabetes centre which provided specialized management mediated by a primary health-care nurse who used a PDA-type blood glucometer with a bar code detector to measure the capillary glucose levels . The control group ( n = 36 )  received usual care . Compared with baseline , HbA1c was significantly reduced at three-month follow-up in the intervention group ( 8.0 % vs. 7.5 % ; P < 0.01 ) , but not in the control group . Total cholesterol was significantly reduced in the intervention group ( 10.7 mmol/L vs. 10.4 mmol/L ; P = 0.043 ) . Fasting plasma glucose and triglyceride levels were lower at follow-up in both groups , but the difference was not significant . The new system could be implemented widely and would contribute to improving the quality of diabetes care , even in isolated rural areas Background To evaluate the efficacy of Counselling and Advisory Care for Health ( COACH ) programme in managing dyslipidaemia among primary care practice s in Malaysia . This open-label , parallel , r and omised controlled trial compared the COACH programme delivered by primary care physicians alone ( PCP arm ) and primary care physicians assisted by nurse educators ( PCP-NE arm ) . Methods This was a multi-centre , open label , r and omised trial of a disease management programme ( COACH ) among dyslipidaemic patients in 21 Malaysia primary care practice s. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia ; 149 were r and omised to the COACH programme delivered by primary care physicians assisted by nurse educators ( PCP-NE ) and 148 to care provided by primary care physicians ( PCP ) alone .  The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms . Secondary endpoints included mean percentage change from baseline of lipid profile ( TC , LDL-C , HDL-C , TG , TC : HDL ratio ) , Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24 . The study also assessed the sustainability of programme efficacy at week 36 . Results Both study arms demonstrated improvement in LDL-C from baseline . The least squares ( LS ) mean change from baseline LDL-C were −30.09 % and −27.54 % for PCP-NE and PCP respectively . The difference in mean change between groups was 2.55 % ( p=0.288 ) , with a greater change seen in the PCP-NE arm . Similar observations were made between the study groups in relation to total cholesterol change at week 24 . Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups , 3.01 % , 95 % CI 0.12 - 5.90 , p=0.041 , at week 24 . There was no significant difference in lipid outcomes between 2 study groups at week 36 ( 12 weeks after the programme had ended ) . Conclusion Patients who received coaching and advice from primary care physicians ( with or without the assistance by nurse educators ) showed improvement in LDL-cholesterol . Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone ; however , the improvements were not maintained when the services were withdrawn . Trial registration National Medical Research Registration ( NMRR ) Number : NMRR-08 - 287 - 1442Trial Registration Number ( Clinical Trials.gov Identifier ) : OBJECTIVE To evaluate the effectiveness of a culturally adapted , primary care – based nurse – community health worker ( CHW ) team intervention to support diabetes self-management on diabetes control and other biologic measures . RESEARCH DESIGN AND METHODS Two hundred sixty-eight Samoan participants with type 2 diabetes were recruited from a community health center in American Samoa and were r and omly assigned by village clusters to the nurse-CHW team intervention or to a wait-list control group that received usual care . RESULTS Participants had a mean age of 55 years , 62 % were female , mean years of education were 12.5 years , 41 % were employed , and mean HbA1c was 9.8 % at baseline . At 12 months , mean HbA1c was significantly lower among CHW participants , compared with usual care , after adjusting for confounders ( b = −0.53 ; SE = 0.21 ; P = 0.03 ) . The odds of making a clinical ly significant improvement in HbA1c of at least 0.5 % in the CHW group was twice the odds in the usual care group after controlling for confounders ( P = 0.05 ) . There were no significant differences in blood pressure , weight , or waist circumference at 12 months between groups . CONCLUSIONS A culturally adapted nurse-CHW team intervention was able to significantly improve diabetes control in the U.S. Territory of American Samoa . This represents an important translation of an evidence -based model to a high-risk population and a re source -poor setting OBJECTIVE To compare the effects of low-level facility-based interventions on patient retention rates for cardiovascular ( CV ) disease in an environment of task shifting and nurse-led care in rural health districts in Central Cameroon . METHODS This study is an open-label , three-arm , cluster-r and omised trial in nurse-led facilities . All three groups implemented a treatment contract . The control group ( group 1 ) had no additional intervention , group 2 received the incentive of 1 month of free treatment every forth month of regularly respected visits , and group 3 received reminder letters in case of a missed follow-up visit . The primary outcome was patient retention at 1 year . Secondary outcomes were adherence to follow-up visit schemes and changes in blood pressure ( BP ) and blood glucose levels . Patients ' monthly spending for drugs and transport was calculated retrospectively . RESULTS A total of 33 centres and 221 patients were included . After 1 year , 109 patients ( 49.3 % ) remained in the programme . Retention rates in groups 2 and 3 were 60 % and 65 % , respectively , against 29 % in the control group . The differences between the intervention groups and the control group were significant ( P < 0.001 ) , but differences between the two intervention groups were not ( P = 0.719 ) . There were no significant differences in BP or fasting plasma glucose trends between retained patients in the study groups . Average monthly cost to patients for antihypertensive medication was € 1.1 ± 0.9 and for diabetics € 1.2 ± 1.1 . Transport costs to the centres were on average € 1.1 ± 1.0 for hypertensive patients and € 1.1 ± 1.6 for patients with diabetes . CONCLUSIONS Low-cost interventions suited to an environment of task shifting and nurse-led care and needing minimal additional re sources can significantly improve retention rates in CV disease management in rural Africa . The combination of a treatment contract and reminder letters in case of missed appointments was an effective measure to retain patients in care AIM This paper reports a study comparing the outcomes of diabetic patients undergoing either early discharge or routine care .  BACKGROUND The hospital is not the best place to monitor the glycaemic control of patients with diabetes with no other morbidity or complications . It is an unnatural environment in which diet is planned and the activity level is low . The hospital is also an expensive place in which to treat patients . METHODS This r and omized controlled trial was conducted in the medical department of a regional hospital in Hong Kong . A total of 101 patients who needed glycaemic monitoring , but who were otherwise fit for discharge , were recruited . The control group continued to receive routine hospital care . The study group was discharged early and received a follow-up programme which included a weekly or biweekly telephone call from a nurse . FINDINGS When compared with the control group , the study group had a greater decrease in HbA1c at 24 weeks , although the statistical difference was marginal ( 7.6 vs. 8.1 , P = 0.06 ) , a higher blood monitoring adherence score at both 12 weeks ( 5.4 vs. 3.6 , P < 0.001 ) and 24 weeks ( 5.3 vs. 3.5 , P < 0.001 ) , and a higher exercise adherence score at 12 weeks ( 5.3 vs. 3.4 , P = 0.001 ) and 24 weeks ( 5.5 vs. 3.2 , P < 0.001 ) . The study group had a shorter hospital stay ( 2.2 vs. 5.9 , P < 0.001 ) , and the net savings were HK$11,888 per patient . CONCLUSION It is feasible to integrate treatment into the real life environments of patients with diabetes , and nurse-led transitional care is a practical and cost-effective model . Nurse follow-up is effective in maintaining optimal glycaemic control and enhancing adherence to health behaviours . Management of glycaemic control is better done in the community than in the hospital AIM The aim of this study was to examine the effect of a cardiac rehabilitation programme on health behaviours and physiological risk parameters in patients with coronary heart disease in Chengdu , China . BACKGROUND Epidemiological studies indicate a dose- , level- and duration -dependent relationship exists between cardiac behavioural and physiological risks and coronary heart disease incidence as well as subsequent cardiac morbidity and mortality . Cardiac risk factor modification has become the very primary goal of modern cardiac rehabilitation programmes . DESIGN METHODS A r and omized controlled trial was conducted . Coronary heart disease patients ( n = 167 ) who met the sampling criteria in two tertiary medical centres in Chengdu , south-west China , were r and omly assigned to either an intervention group ( the cardiac rehabilitation programme ) or control group ( the routine care ) . The change of health behaviours ( walking performance , step II diet adherence , medication adherence , smoking cessation ) and physiological risk parameters ( serum lipids , blood pressure , body weight ) were assessed to evaluate the programme effect . RESULTS Patients in the intervention group demonstrated a significantly better performance in walking , step II diet adherence , medication adherence ; a significantly greater reduction in serum lipids including triglyceride , total cholesterol , low-density lipoprotein ; and significantly better control of systolic and diastolic blood pressure at three months . The majority of these positive impacts were maintained at six months . The effect of the programme on smoking cessation , body weight , serum high-density lipoprotein , was not confirmed . CONCLUSIONS A cardiac rehabilitation programme led by a nurse can significantly improve the health behaviours and cardiac physiological risk parameters in coronary heart disease patients . Nurses can fill significant treatment gaps in the risk factor management of patients with coronary heart disease . RELEVANCE TO CLINICAL PRACTICE This study raises attention regarding the important roles nurses can play in cardiac rehabilitation and the unique way for nurses to meet the rehabilitative care needs of coronary heart disease patients . Furthermore , the hospital-home bridging nature of the programme also created a model for interfacing the acute care and community rehabilitative care BACKGROUND Patients with end stage renal failure require dialysis and strict adherence to treatment plans to sustain life . However , non-adherence is a common and serious problem among patients with chronic kidney disease . There is a scarcity of studies in examining the effects of disease management programmes on patients with chronic kidney disease . OBJECTIVES This paper examines whether the study group receiving the disease management programme  have better improvement than the control group , comparing outcomes at baseline ( O1 ) , at 7 weeks at the completion of the programme ( O2 ) and at 13 weeks ( O3 ) . METHODS This is a r and omized controlled trial . The outcome measures were non-adherence in diet , fluid , dialysis and medication , quality of life , satisfaction , symptom control , complication control and health service utilisation . RESULTS There was no significant difference between the control and study group for the baseline measures , except for sleep . Significant differences ( p<0.05 ) were found between the control and study group at O2 in the outcome measures of diet degree non-adherence , sleep , symptom , staff encouragement , overall health and satisfaction . Sustained effects at O3 were noted in the outcome measures of continuous ambulatory peritoneal dialysis ( CAPD ) non-adherence degree , sleep , symptom , and effect of kidney disease . CONCLUSIONS Many studies exploring chronic disease management have neglected the group with end stage renal failure and this study fills this gap . This study has employed an innovative model of skill mix using specialist and general nurses and demonstrated patient improvement in diet non-adherence , CAPD non-adherence , aspects of quality of life and satisfaction with care . Re design ing chronic disease management programmes helps to optimize the use of different levels of skills and re sources to bring about positive outcomes AIM To determine whether a nurse telephone follow-up service could improve the level of adherence to a diabetes therapeutic regimen for patients with type 2 diabetes . METHODS A total of 61 patients attended a 3 day diabetes self-care program at the Iranian Diabetes Society . They were r and omly assigned to one of the experimental or control groups . A telephone follow-up program was applied to the experimental group for 3 months , twice per week for the first month and weekly for the second and third months . The data - collection instruments included a data sheet to record the glycosylated hemoglobin ( HbA1c ) level and a question naire . The data were collected at baseline and after 12 weeks . RESULTS There were significant differences between the control and the experimental groups in their adherence to a diabetic diet , exercise , foot care , blood glucose monitoring , and medication-taking . Also , the HbA1c levels differed significantly between the two groups after 3 months . CONCLUSION A nurse-led telephone follow-up was effective in enhancing the level of adherence to a diabetes therapeutic regimen , such that the HbA1c level decreased BACKGROUND Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications . AIM The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin ( HbA1c ) levels and adherence to diabetes control recommendations . METHODS A r and omized design with control and experimental groups being assessed pre- and post intervention was used to assess the effectiveness of nurse telephone calls .  Twenty patients were r and omly assigned to an intervention group and 16 to a control group . The goal of the intervention was to keep blood glucose concentrations close to the normal range ( HbA1c < 7 % ) . The intervention was applied to the intervention group for 12 weeks , and consisted of continued education and reinforcement of diet , exercise , medication adjustment recommendations , as well as frequent self-monitoring of blood glucose levels . Telephone intervention was performed twice per week for the first month and then weekly for the second and third month . Participants were requested to write self-management logs including blood glucose levels , diet and an exercise diary . A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail . All medication adjustments were communicated to participants ' doctors . The HbA1c and diabetes adherence were measured before and after the intervention . RESULTS Patients in the intervention group had a mean decrease of 1.2 % in HbA1c levels and those in the control group had a mean increase of 0.6 % in HbA1c levels . The intervention group had greater diet and blood glucose testing adherence than the control group . CONCLUSION These findings indicate that a nurse telephone intervention can improve HbA1c , and diet and blood glucose testing adherence AIM To test the effects of a postdischarge transitional care programme among patients with coronary heart disease . BACKGROUND . Coronary heart disease is a leading cause of death worldwide . Effective postdischarge care can help patients maintain a healthy lifestyle and thereby control the risk factors . Transitional care is under-developed in mainl and China . DESIGN A r and omised controlled trial . METHOD The control group ( n = 100 ) received routine care and the study group ( n = 100 ) received the postdischarge transitional care programme , which consisted of predischarge assessment , structured home visits and telephone follow-ups within four weeks after discharge .  Subjects were recruited in 2002 - 2003 , with data collected at baseline before discharge , two days and four and 12 weeks after discharge . RESULTS Participants in the study group had significantly better underst and ing in diet , medications and health-related lifestyle behaviour at day 2 and in weeks 4 and 12 and better underst and ing in exercise at weeks 4 and 12 . There were significant differences between the control and study groups in diet and health-related lifestyle at day 2 and weeks 4 and 12 , in medication at weeks 4 and 12 and exercise at week 12 . There was no difference in hospital readmission between the two groups . The study group was very satisfied with the care . There was no difference in willingness to pay for nurse follow-up services between groups . CONCLUSION This study is an original effort to establish and test a nurse-led transitional care model in China . Results demonstrate that transitional care is effective in mainl and China , concurring with studies done elsewhere . RELEVANCE TO CLINICAL PRACTICE This study has constructed a transitional care model for patients with coronary heart disease in the context of the Chinese population which is effective in enhancing healthy lifestyle among these patients AIM The aim of this study was to determine the effect of anti-hypertensive patient-oriented education and in-home monitoring for medication adherence and management of hypertension in a primary care setting , by providing education on healthy lifestyle behaviours and medication adherence . BACKGROUND Hypertension is the third most common cause of death worldwide . Prevalence of hypertension in Turkey is approximately 30 % in the general population and 45 - 50 % in population over 50 . DESIGN R and omised controlled study . METHODS This study conducted in Turkey used a study group comprised of 120 subjects ( 40 Group A , 40 Group B , 40 controls ) , all previously diagnosed with hypertension and who started medication therapy at least one year prior to start of study . The study was conducted between February-November 2006 at public primary health care facilities and homes of the study participants . Participants in Group A and B received a total of six monthly education sessions , four times during clinic visits and two home visits . Medication adherence education for Groups A and B and education about healthy lifestyle behaviours for Group B were administered in a structured and individualised format . The control group was routinely monitored in health care facilities . RESULTS Healthy lifestyle behaviours and perception of self-efficacy regarding medication adherence showed improvement after education sessions in Groups A and B. Systolic and diastolic blood pressures of subjects in Group A and B showed a significant decrease compared with those of the control group ; the blood pressure decrease in Group B was greater than in Group A. CONCLUSION Nurses play an important role in uncontrolled hypertension detection and can improve medication adherence and healthy lifestyle behaviours . RELEVANCE TO CLINICAL PRACTICE Patient education medication adherence alone and in combination with healthy lifestyle behaviour teaching is an effective tool for blood pressure reduction in the hypertensive population in primary health care setting
target: Conclusions There is a dearth of evidence on the implementation of task-shifting strategies to reduce the burden of CVD in LMICs .
background: Objective To evaluate evidence from published r and omised controlled trials ( RCTs ) for the use of task-shifting strategies for cardiovascular disease ( CVD ) risk  reduction in low-income and middle-income countries ( LMICs ) .