title: Nurse management of hypertension in rural western Kenya: implementation research to optimize delivery.
abstract: BACKGROUND
  Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and insufficient human resource capacity is among the contributing factors. Thus, a critical component of hypertension management is to develop novel and effective solutions to the human resources challenge. One potential solution is task redistribution and nurse management of hypertension in these settings.
  
  
  OBJECTIVE
  The aim of this study is to investigate whether nurses can effectively reduce blood pressure in hypertensive patients in rural western Kenya and, by extension, throughout sub-Saharan Africa.
  
  
  METHODS
  An initial phase of qualitative inquiry will assess facilitators and barriers of nurse management of hypertension. In addition, we will perform usability and feasibility testing of a novel, electronic tablet-based integrated decision-support and record-keeping tool for the nurses. An impact evaluation of a pilot program for nurse-based management of hypertension will be performed. Finally, a needs-based workforce estimation model will be used to estimate the nurse workforce requirements for stable, long-term treatment of hypertension throughout western Kenya.
  
  
  RESULTS
  The primary outcome measure of the impact evaluation will be the change in systolic blood pressure of hypertensive individuals assigned to nurse-based management after 1 year of follow-up. The workforce estimation modeling output will be the full-time equivalents of nurses.
  
  
  CONCLUSIONS
  This study will provide evidence regarding the effectiveness of strategies to optimize task redistribution and nurse-based management of hypertension that can be applicable to noncommunicable disease management in low- and middle-income countries.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: rajesh.vedanthan@mssm.edu.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vedanthan
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Jemima H
authors.initials: JH
authors.lastname: Kamano
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Horowitz
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Deborah
authors.initials: D
authors.lastname: Ascheim
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: Moi University College of Health Sciences, Eldoret, Kenya.
authors.forename: Sylvester
authors.initials: S
authors.lastname: Kimaiyo
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
mesh_terms: D001794:Blood Pressure; D034201:Computers, Handheld; D005240:Feasibility Studies; D006801:Humans; D006973:Hypertension / Q000451:nursing*; D007630:Kenya; D009726:Nurses / Q000600:supply & distribution; D057184:Practice Patterns, Nurses'; D016730:Program Development; D015397:Program Evaluation; D012107:Research Design; D019035:Rural Health Services
keywords: facilitators and barriers; hypertension; impact evaluation; implementation research; low- and middle-income countries; nurse management; usability and feasibility testing; workforce estimation
references.citation: Lancet. 2008 Mar 15;371(9616):915-22
references.pmid: 18342686
references.citation: Soc Sci Med. 2006 Jun;62(11):2810-25
references.pmid: 16352385
references.citation: Am J Health Promot. 1990 Mar-Apr;4(4):279-87
references.pmid: 10106505
references.citation: BMC Public Health. 2010 Sep 22;10:569
references.pmid: 20860807
references.citation: JAMA. 2003 May 21;289(19):2560-72
references.pmid: 12748199
references.citation: Lancet. 2008 Sep 13;372(9642):910-6
references.pmid: 18790314
references.citation: J Hypertens. 2009 May;27(5):963-75
references.pmid: 19402221
references.citation: Glob Public Health. 2011;6(3):293-306
references.pmid: 20845123
references.citation: Nat Rev Cardiol. 2011 Feb;8(2):114-7
references.pmid: 21045785
references.citation: Stud Health Technol Inform. 2010;160(Pt 1):525-9
references.pmid: 20841742
references.citation: Lancet. 2010 Nov 20;376(9754):1785-97
references.pmid: 21074253
references.citation: J Epidemiol Community Health. 2010 Apr;64(4):360-5
references.pmid: 19692732
references.citation: Bull World Health Organ. 2004 Jul;82(7):503-8
references.pmid: 15500283
references.citation: Int J Environ Res Public Health. 2007 Jun;4(2):93-100
references.pmid: 17617671
references.citation: AMIA Annu Symp Proc. 2008 Nov 06;:26-30
references.pmid: 18999075
references.citation: Scand J Public Health Suppl. 2007 Aug;69:52-9
references.pmid: 17676503
references.citation: Ethn Dis. 2003 Summer;13(3):310-5
references.pmid: 12894954
references.citation: BMJ. 2010 Aug 23;341:c3995
references.pmid: 20732968
references.citation: JAMA. 2003 Sep 24;290(12):1624-32
references.pmid: 14506122
references.citation: J Acquir Immune Defic Syndr. 2009 Nov;52 Suppl 1:S54-7
references.pmid: 19858941
references.citation: Lancet. 2005 Jan 15-21;365(9455):217-23
references.pmid: 15652604
references.citation: Ethn Dis. 2007 Winter;17(1):49-54
references.pmid: 17274209
references.citation: J Hypertens. 2003 Nov;21(11):1983-92
references.pmid: 14597836
references.citation: Bull World Health Organ. 2008 Jul;86(7):516-523B
references.pmid: 18670663
references.citation: Cochrane Database Syst Rev. 2005 Apr 18;(2):CD001271
references.pmid: 15846614
references.citation: Mt Sinai J Med. 2011 May-Jun;78(3):303-5
references.pmid: 21598257
references.citation: BMC Public Health. 2007 Nov 13;7:326
references.pmid: 17999764
references.citation: Hypertension. 2007 Dec;50(6):1012-8
references.pmid: 17954720
references.citation: Acta Trop. 2001 Jun 22;79(3):231-9
references.pmid: 11412807
references.citation: Stud Health Technol Inform. 2010;160(Pt 1):371-5
references.pmid: 20841711
references.citation: Lancet. 2011 Feb 12;377(9765):568-77
references.pmid: 21295844
references.citation: Global Health. 2009 Sep 22;5:10
references.pmid: 19772644
references.citation: Ann Intern Med. 2005 Nov 15;143(10):729-36
references.pmid: 16287794
references.citation: Hum Resour Health. 2006 Jan 26;4:1
references.pmid: 16438710
references.citation: Lancet. 2002 Dec 14;360(9349):1903-13
references.pmid: 12493255
references.citation: Ann Intern Med. 2006 Aug 15;145(4):273-83
references.pmid: 16908918
references.citation: Arch Intern Med. 2009 Oct 26;169(19):1748-55
references.pmid: 19858431
references.citation: Lancet. 2012 Dec 15;380(9859):2224-60
references.pmid: 23245609
references.citation: J Chronic Dis. 1967 Aug;20(8):637-48
references.pmid: 4860352
references.citation: BMJ. 2005 Mar 19;330(7492):637-9
references.pmid: 15774994
references.citation: Glob Public Health. 2011;6(3):247-56
references.pmid: 21390970
references.citation: Hypertension. 2004 May;43(5):1017-22
references.pmid: 15037552
references.citation: J Hum Hypertens. 2010 Dec;24(12):786-95
references.pmid: 20220771
references.citation: J Int AIDS Soc. 2009 Oct 08;12:23
references.pmid: 19814814
references.citation: J Am Med Inform Assoc. 2011 Mar-Apr;18(2):150-5
references.pmid: 21252053
references.citation: J Infect Dis. 2007 Dec 1;196 Suppl 3:S464-8
references.pmid: 18181695
references.citation: Ethn Dis. 2006 Autumn;16(4):894-9
references.pmid: 17061743
references.citation: J Health Care Poor Underserved. 2004 Nov;15(4):631-44
references.pmid: 15531820
references.citation: Hum Resour Health. 2008 Feb 07;6:3
references.pmid: 18257931
references.citation: PLoS Med. 2009 Oct;6(10):e1000163
references.pmid: 19823569
references.citation: Arch Intern Med. 2009 Oct 26;169(19):1788-94
references.pmid: 19858437
references.citation: Lancet. 2007 Dec 22;370(9605):2158-63
references.pmid: 17574662
references.citation: BMC Pediatr. 2008 Oct 02;8:39
references.pmid: 18831747
references.citation: Int J Med Inform. 2010 Mar;79(3):204-10
references.pmid: 20089444
references.citation: Am Heart J. 2011 May;161(5):842-7
references.pmid: 21570512
references.citation: J Biosoc Sci. 2008 Jan;40(1):35-52
references.pmid: 17767790
references.citation: Circulation. 2009 May 19;119(19):2633-42
references.pmid: 19451365
references.citation: J Hypertens. 2009 Jul;27(7):1472-7
references.pmid: 19474763
references.citation: J Biosoc Sci. 2004 Jul;36(4):433-43
references.pmid: 15293385
references.citation: J Am Coll Cardiol. 2011 May 17;57(20):1980-7
references.pmid: 21565635
references.citation: Stud Health Technol Inform. 2007;129(Pt 1):372-6
references.pmid: 17911742
references.citation: Acad Med. 2007 Aug;82(8):812-8
references.pmid: 17762264