Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala
Background: The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study’s objective is to report outcomes from a pilot implementation trial of integrated hypertension and dia...
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| Format: | Article |
| Language: | English |
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Ubiquity Press
2025-01-01
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| Series: | Global Heart |
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| Online Access: | https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1397 |
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| author | Irmgardt Alicia Wellmann Luis Fernando Ayala Taryn M. Valley Vilma Irazola Mark D. Huffman Michele Heisler Peter Rohloff Rocío Donis Eduardo Palacios Manuel Ramírez-Zea David Flood |
| author_facet | Irmgardt Alicia Wellmann Luis Fernando Ayala Taryn M. Valley Vilma Irazola Mark D. Huffman Michele Heisler Peter Rohloff Rocío Donis Eduardo Palacios Manuel Ramírez-Zea David Flood |
| author_sort | Irmgardt Alicia Wellmann |
| collection | DOAJ |
| description | Background: The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study’s objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guatemala. Methods: We conducted a single-arm pilot implementation trial over six months from October 2023 to May 2024 in 11 Guatemalan Ministry of Health primary care facilities in two districts. The pilot evaluated a package of five HEARTS-aligned implementation strategies to improve the pharmacological treatment of hypertension and diabetes. The primary outcomes were feasibility and acceptability, measured through 20 structured interviews with Ministry of Health employees and by examining enrolment and retention data. Secondary outcomes included a suite of implementation and clinical outcomes, including treatment rates. When baseline data were available, we analyzed secondary outcomes as the net change from baseline or using an interrupted time series approach. Results: The study enrolled 964 patients, of whom 58.8% had hypertension only, 30.4% had diabetes only, and 10.8% had both conditions. Surveys on feasibility and acceptability among Ministry of Health staff had a median score of 5.0 (IQR: 5.0 to 5.0) and 5.0 (IQR range: 4.8 to 5.0), respectively, exceeding the prespecified benchmark of ≥3.5. Both districts achieved the prespecified benchmark of enrolling ≥25 hypertension patients and ≥25 diabetes patients. Only 36% of patients attended a follow-up visit within three months, lower than the prespecified benchmark of ≥75%. Monthly treatment rates during the pilot increased by 22.3 (95% CI: 16.2 to 28.4; P < 0.001) and 3.5 (95% CI: –1.6 to 8.7; P = 0.17) patients per month for hypertension and diabetes, respectively. Conclusions: Implementation of an integrated hypertension and diabetes model based on HEARTS was generally feasible and acceptable in the Ministry of Health in Guatemala. Findings can refine national scale-up in Guatemala and inform HEARTS implementation projects in other settings. |
| format | Article |
| id | doaj-art-838eff1ce8c640baabf6b82d2cedca1d |
| institution | Kabale University |
| issn | 2211-8179 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Ubiquity Press |
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| series | Global Heart |
| spelling | doaj-art-838eff1ce8c640baabf6b82d2cedca1d2025-02-11T05:32:44ZengUbiquity PressGlobal Heart2211-81792025-01-012019910.5334/gh.13971378Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in GuatemalaIrmgardt Alicia Wellmann0https://orcid.org/0000-0003-0184-5817Luis Fernando Ayala1https://orcid.org/0009-0000-5551-471XTaryn M. Valley2https://orcid.org/0000-0003-2866-9518Vilma Irazola3https://orcid.org/0000-0002-6100-1862Mark D. Huffman4https://orcid.org/0000-0001-7412-2519Michele Heisler5https://orcid.org/0000-0002-6889-2063Peter Rohloff6https://orcid.org/0000-0001-7274-8315Rocío Donis7https://orcid.org/0009-0001-8848-4294Eduardo Palacios8Manuel Ramírez-Zea9https://orcid.org/0000-0001-5107-9175David Flood10https://orcid.org/0000-0002-4372-7387INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala CityINCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala CityDepartment of Anthropology, University of Wisconsin-Madison, Madison; School of Medicine and Public Health, University of Wisconsin-Madison, MadisonInstitute for Clinical Effectiveness and Health Policy, Buenos AiresDepartment of Medicine and Global Health Center, Washington University in St Louis, St Louis, Missouri; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, US; The George Institute for Global Health, University of New South Wales, SydneyDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MICenter for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, GT; Division of Global Health Equity, Brigham, and Women’s Hospital, Boston, MassachusettsNational Program for the Prevention of Chronic Non-Communicable Diseases and Cancer Ministry of Health, Guatemala CityNational Program for the Prevention of Chronic Non-Communicable Diseases and Cancer Ministry of Health, Guatemala CityINCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala CityINCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Center for Indigenous Health Research, Wuqu’ Kawoq, TecpánBackground: The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study’s objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guatemala. Methods: We conducted a single-arm pilot implementation trial over six months from October 2023 to May 2024 in 11 Guatemalan Ministry of Health primary care facilities in two districts. The pilot evaluated a package of five HEARTS-aligned implementation strategies to improve the pharmacological treatment of hypertension and diabetes. The primary outcomes were feasibility and acceptability, measured through 20 structured interviews with Ministry of Health employees and by examining enrolment and retention data. Secondary outcomes included a suite of implementation and clinical outcomes, including treatment rates. When baseline data were available, we analyzed secondary outcomes as the net change from baseline or using an interrupted time series approach. Results: The study enrolled 964 patients, of whom 58.8% had hypertension only, 30.4% had diabetes only, and 10.8% had both conditions. Surveys on feasibility and acceptability among Ministry of Health staff had a median score of 5.0 (IQR: 5.0 to 5.0) and 5.0 (IQR range: 4.8 to 5.0), respectively, exceeding the prespecified benchmark of ≥3.5. Both districts achieved the prespecified benchmark of enrolling ≥25 hypertension patients and ≥25 diabetes patients. Only 36% of patients attended a follow-up visit within three months, lower than the prespecified benchmark of ≥75%. Monthly treatment rates during the pilot increased by 22.3 (95% CI: 16.2 to 28.4; P < 0.001) and 3.5 (95% CI: –1.6 to 8.7; P = 0.17) patients per month for hypertension and diabetes, respectively. Conclusions: Implementation of an integrated hypertension and diabetes model based on HEARTS was generally feasible and acceptable in the Ministry of Health in Guatemala. Findings can refine national scale-up in Guatemala and inform HEARTS implementation projects in other settings.https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1397implementation researchhealth policy and systems researchglobal healthhypertensiondiabetesguatemalawho hearts technical package |
| spellingShingle | Irmgardt Alicia Wellmann Luis Fernando Ayala Taryn M. Valley Vilma Irazola Mark D. Huffman Michele Heisler Peter Rohloff Rocío Donis Eduardo Palacios Manuel Ramírez-Zea David Flood Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala Global Heart implementation research health policy and systems research global health hypertension diabetes guatemala who hearts technical package |
| title | Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala |
| title_full | Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala |
| title_fullStr | Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala |
| title_full_unstemmed | Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala |
| title_short | Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala |
| title_sort | evaluating the world health organization s hearts model for hypertension and diabetes management a pilot implementation study in guatemala |
| topic | implementation research health policy and systems research global health hypertension diabetes guatemala who hearts technical package |
| url | https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1397 |
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