Evaluation of the effect of task shifting and use of standardized hypertension treatment and care protocol in adults in Rwanda 2018

Abstract

Background: Sub-Saharan Africa faces a disproportional shortage of doctors and capacity to manage the rising incidence of chronic illnesses like hypertension. Rwanda has responded to this shortage by initiating nurse-led management of hypertension and by developing hypertension treatment and care protocols to use in primary health care settings. We assessed the effect of task shifting and use of the standardized protocols in Rwanda. Methods: This retrospective cross sectional study included Patients with hypertension, followed in five non-communicable disease clinics across district hospitals, were grouped into two groups. Group 1 included patients with hypertension followed in nurse-run clinics following task shifting from physicians to nurses (Byumba, Masaka and Gitwe) and group 2 included patients with hypertension who are still followed in physician-run clinics (Kabgayi and Murunda). Both nurse-run clinics and physician-run clinics followed a standardized treatment and care protocol. Clinical data from the two cohorts were abstracted to determine changes in patients’ blood pressure after task shifting. Results: 259 eligible patients were included in the study; 102 were followed in physician-run clinics and 157 patients in nurse-run clinics. Prior to task shifting and use of standardized treatment protocol, the mean SBP across study participants was 159.9 mmHg which significantly reduced by an average of 26.07 mmhg (CI:22.63 -29.5) in one year of follow up after task shifting (p<0.001). Additionally, a significant difference mean systolic blood pressure is higher in nurse led clinics of