Evaluating the role of pharmacists and m-Health strategies in the management of hypertension in General Pueyrredon

Background

Hypertension is one of the main cardiovascular risk factors in Argentina, with a high prevalence (36%) and an important social, economic and health impact. Despite the availability of highly effective treatment and preventive strategies, only half of hypertensive patients are aware of their condition and the majority are not appropriately controlled.

Integration of pharmacies to the public health care system and the use of information & communication technologies (ICTs) are two of the strategies that have shown to be effective in the improvement of hypertensive patients’ management.

Aims

This proposal was aimed at evaluating the access, acceptability, adoption and impact of an innovating program at the Municipality of General Pueyrredón, Province of Buenos Aires, Argentina. The program called “FarmaTeCuida” was based on the integration of private pharmacies to the municipal public health system and the use of ICTs for the diagnosis, treatment and follow-up of adult hypertensive (HT) patients depending on public health coverage.

Project plan

A mixed-method study was conducted. The quantitative component includes a quasi-experimental, prospective, longitudinal design, involving a cohort of hypertensive patients included in the community program. All those who give their informed consent at the pharmacy and who were diagnosed as “new hypertensive” or “already diagnosed or under treatment hypertensive patient” were included in the program. The qualitative component included in-depth interviews to assess program acceptability, adoption and impact at different levels. On the basis of an equity principle, the implementation of the program was targeted to people only having public health coverage and comprised three stage: pre-implementation; implementation and post-implementation. The research hypothesis, the design of the implementation strategy and the evaluation framework were informed by the conceptual model for theorizing and evaluating non-adoption, abandonment, and challenges to the scale-up, spread, and sustainability of health technologies, published by Greenhalgh et al.

Due to the interruptions caused by the COVID-19 pandemic and the prolonged quarantine that was held in Argentina, the original research protocol had to be adapted. Program implementation was delayed for eight months and was later extended for 12 months. In spite of all the financial and technical obstacles that aroused in the research execution, the post-implementation stage could be completed with the support of experts from the London School of Hygiene and Tropical Medicine. A quantitative and qualitative evaluation of the program impact on hypertensive levels of enrolled patients as well as barriers and facilitators to its implementation was performed.

Impact

The partnership between the project team and policymakers led to changes in municipal health policies and programs and the training of healthcare personnel. Evidence from the project was used by the Secretary of Health to further enhance health team capacities, and in collaboration with the National Academy of Medicine, initiated a second training program targeting healthcare teams working at the Primary Health Care Centres.

Funding organisations

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