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Publication date: 
May 25, 2022

***This article is published as a preprint.***

Abstract

Brazil HealthRise community-based program focused on improving technologies for care coordination, developing the local workforce, and identifying and educating individuals with hypertension and diabetes.

Objectives 

To assess the impact of HealthRise on hypertension and diabetes management among patients in the region of Teófilo Otoni (TO) and in the city of Vitória da Conquista (VC).

Methods 

Grantees routinely collected patient-level clinical in intervention areas from March 2017 to December 2018; endline qualitative interviews were conducted with patients, providers, administrators, and policymakers in both intervention and comparison sites. Paired t-tests were employed to measure the potential impact of the program on reducing systolic blood pressure (SBP) and hemoglobin A1c (HbA1c) between baseline and endline, and on increasing the percentage of enrollees meeting clinical targets (SBP < 140 mmHg for hypertension; < 8% HbA1c for diabetes). We analyzed qualitative data using thematic coding.

Results 

Across sites, 2,764 hypertension patients and 244 diabetes patients were followed through endline. Participants experienced reductions in SBP in TO (−1.9 mmHg [−3.1;−0.7]) and VC (−4,2 mmHg [−5.2;−3.1]); more hypertension patients met treatment targets in these locations (TO: +3.9 percentage-points [0.4;7.2]; VC: +10.5 percentage-points [7.81;13.2]) by endline. HbA1c decreased in TO (−0.6 [−0.9;−0.4]) and VC (−0.9 [−1.4;−0.5]), and more individuals presented HbA1c < 8% by endline (TO: +10.2 percentage-points [3.8, 16.6]; VC: +25 percentage-points [12.2, 37.8]). Qualitative data pointed to overall enthusiasm for new technologies and care routine implemented by HealthRise, but challenges regarding program implementation, integration with other levels of care, and social determinants of health persisted.

Conclusions 

Program showed positive effects on hypertension and diabetes outcomes. Community-based health interventions can help bridge healthcare gaps, but their full impact will remain limited until multisectoral policies and actions address underlying structural and social determinants of health more effectively.

Competing Interest Statement

PB and JD are employees of the Medtronic Foundation. MTUB is a former Medtronic Foundation advisor. WWA, VMB, MALB, CCRC, MLC, PWE, CNK, MMOL, JAL, JXM, MSM, DSM, SM, JAQO, MGO, VSOAP, ALPR, DR, KOS, and DAS are recipients of HealthRise grants from the Medtronic Foundation to implement HealthRise interventions. LSF, SW, JNC, NF, KPH, CRM, MN, BKP, BT, and EG are recipients of funding from grants from the Medtronic Foundation to evaluate HealthRise interventions.

Funding Statement

Funding for the HealthRise project came from the Medtronic Foundation. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. This study was financed in part by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brazil (CAPES) - Finance Code 001. JAQO and ALPR received support from the Instituto de Avaliacao de Tecnologia em Saude (IATS) and the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Brazil. ALPR was supported in part by Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). MGO received funding from the Bahia State Research Support Foundation, the Federal University of Bahia, and the Municipal Health Secretariat of Vitoria da Conquista. Funders had no role in the study design, data collection, analysis, interpretation of data, or writing of the first draft of this manuscript.

Citation: 

Flor LS, Wilson S, Wildes Amorim W, et al. Endline assessment of a community-based program on hypertension and diabetes management in Brazil. MedRxiv. 25 May 2022. doi: 10.1101/2022.05.22.22275385.