The burden of noncommunicable diseases (NCDs) is rising globally; hypertension, a chronic NCD, is the world’s leading single cause of death. Chronic NCDs, including hypertension, require health systems to treat large numbers of patients for extended periods of time. Despite the increasing burden of hypertension and other NCDs on health care services, the world faces a shortage of trained health care workers to meet this demand, particularly in low-and middle-income countries. Team-based care, or strategic redistribution of work among a diversity of health care worker types as part of a coordinated practice team, is a health care delivery model that can be the bridge from a physician independent hypertension control program to one shared across different health care worker categories working synergistically to achieve disease control. Team-based care allows care to be decentralized from hospitals to primary health care facilities and to the local community outside the walls of health care facilities, leading to increased efficiency as well as improved access to health care for patients. Team-based care requires multi-sectoral and multi-level cooperation and effort. A team-based care approach to hypertension control requires organizing workflow to provide screening of hypertension and other chronic conditions among all people attending health facilities, a standardized treatment protocol for hypertension management, patient follow-up systems, referral linkages, monitoring and evaluation, and continuous quality improvement. When determining roles and responsibilities of team members, the complexity of tasks should be considered, as should any legal, or regulatory, constraints in the local jurisdiction. To motivate team members, financial or non-financial incentives can be considered, but they must be supported by strong and sensible performance-based indicators. Lastly, effective systems of governance are necessary to facilitate sustained support for team-based care. Despite the challenges of implementation, team-based care has an established track record of success. Examples of team-based care for hypertension control in India, Thailand, Ghana, South Africa, Trinidad and Tobago, and the United States (all documented in this guide) resulted in improvements in hypertension screening, diagnosis, treatment adherence and control rates, as well as improved community support. These examples are consistent with the overall evidence supporting team-based care in the scientific literature. Taken together, this evidence illustrates both the enabling factors and the obstacles new team-based care initiatives will likely encounter…more
Team-Based Hypertension Management in Primary Health Care
