Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala

Autores
Wellmann, Irmgardt Alicia; Ayala, Luis Fernando; Valley, Taryn M.; Irazola, Vilma; Huffman, Mark D.; Heisler, Michele; Rohloff, Peter; Donis, Rocío; Palacios, Eduardo; Ramírez Zea, Manuel; Flood, David
Año de publicación
2025
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
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.
Fil: Wellmann, Irmgardt Alicia. Institute Of Nutrition Of Central America And Panama; Panamá
Fil: Ayala, Luis Fernando. Institute Of Nutrition Of Central America And Panama; Panamá
Fil: Valley, Taryn M.. University of Wisconsin; Estados Unidos
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Huffman, Mark D.. Washington University in St. Louis; Estados Unidos
Fil: Heisler, Michele. University of Michigan; Estados Unidos
Fil: Rohloff, Peter. Center For Indigenous Health Research; Guatemala
Fil: Donis, Rocío. No especifíca;
Fil: Palacios, Eduardo. No especifíca;
Fil: Ramírez Zea, Manuel. Institute Of Nutrition Of Central America And Panama; Panamá
Fil: Flood, David. Institute Of Nutrition Of Central America And Panama; Panamá
Materia
Guatemala
WHO HEARTS technical package
diabetes
global health
health policy and systems research
hypertension
implementation research
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/291176
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/291176
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in GuatemalaWellmann, Irmgardt AliciaAyala, Luis FernandoValley, Taryn M.Irazola, VilmaHuffman, Mark D.Heisler, MicheleRohloff, PeterDonis, RocíoPalacios, EduardoRamírez Zea, ManuelFlood, DavidGuatemalaWHO HEARTS technical packagediabetesglobal healthhealth policy and systems researchhypertensionimplementation researchhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: 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.Fil: Wellmann, Irmgardt Alicia. Institute Of Nutrition Of Central America And Panama; PanamáFil: Ayala, Luis Fernando. Institute Of Nutrition Of Central America And Panama; PanamáFil: Valley, Taryn M.. University of Wisconsin; Estados UnidosFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Huffman, Mark D.. Washington University in St. Louis; Estados UnidosFil: Heisler, Michele. University of Michigan; Estados UnidosFil: Rohloff, Peter. Center For Indigenous Health Research; GuatemalaFil: Donis, Rocío. No especifíca;Fil: Palacios, Eduardo. No especifíca;Fil: Ramírez Zea, Manuel. Institute Of Nutrition Of Central America And Panama; PanamáFil: Flood, David. Institute Of Nutrition Of Central America And Panama; PanamáUbiquity Press2025-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/291176Wellmann, Irmgardt Alicia; Ayala, Luis Fernando; Valley, Taryn M.; Irazola, Vilma; Huffman, Mark D.; et al.; Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala; Ubiquity Press; Global Heart; 20; 1; 1-2025; 1-172211-81602211-8179CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1397info:eu-repo/semantics/altIdentifier/doi/10.5334/gh.1397info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-08-25T15:35:14Zoai:ri.conicet.gov.ar:11336/291176instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982026-08-25 15:35:14.327CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala
title Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala
spellingShingle Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala
Wellmann, Irmgardt Alicia
Guatemala
WHO HEARTS technical package
diabetes
global health
health policy and systems research
hypertension
implementation research
title_short 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_sort Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala
dc.creator.none.fl_str_mv Wellmann, Irmgardt Alicia
Ayala, Luis Fernando
Valley, Taryn M.
Irazola, Vilma
Huffman, Mark D.
Heisler, Michele
Rohloff, Peter
Donis, Rocío
Palacios, Eduardo
Ramírez Zea, Manuel
Flood, David
author Wellmann, Irmgardt Alicia
author_facet Wellmann, Irmgardt Alicia
Ayala, Luis Fernando
Valley, Taryn M.
Irazola, Vilma
Huffman, Mark D.
Heisler, Michele
Rohloff, Peter
Donis, Rocío
Palacios, Eduardo
Ramírez Zea, Manuel
Flood, David
author_role author
author2 Ayala, Luis Fernando
Valley, Taryn M.
Irazola, Vilma
Huffman, Mark D.
Heisler, Michele
Rohloff, Peter
Donis, Rocío
Palacios, Eduardo
Ramírez Zea, Manuel
Flood, David
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Guatemala
WHO HEARTS technical package
diabetes
global health
health policy and systems research
hypertension
implementation research
topic Guatemala
WHO HEARTS technical package
diabetes
global health
health policy and systems research
hypertension
implementation research
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv 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.
Fil: Wellmann, Irmgardt Alicia. Institute Of Nutrition Of Central America And Panama; Panamá
Fil: Ayala, Luis Fernando. Institute Of Nutrition Of Central America And Panama; Panamá
Fil: Valley, Taryn M.. University of Wisconsin; Estados Unidos
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Huffman, Mark D.. Washington University in St. Louis; Estados Unidos
Fil: Heisler, Michele. University of Michigan; Estados Unidos
Fil: Rohloff, Peter. Center For Indigenous Health Research; Guatemala
Fil: Donis, Rocío. No especifíca;
Fil: Palacios, Eduardo. No especifíca;
Fil: Ramírez Zea, Manuel. Institute Of Nutrition Of Central America And Panama; Panamá
Fil: Flood, David. Institute Of Nutrition Of Central America And Panama; Panamá
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.
publishDate 2025
dc.date.none.fl_str_mv 2025-01
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/291176
Wellmann, Irmgardt Alicia; Ayala, Luis Fernando; Valley, Taryn M.; Irazola, Vilma; Huffman, Mark D.; et al.; Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala; Ubiquity Press; Global Heart; 20; 1; 1-2025; 1-17
2211-8160
2211-8179
CONICET Digital
CONICET
url http://hdl.handle.net/11336/291176
identifier_str_mv Wellmann, Irmgardt Alicia; Ayala, Luis Fernando; Valley, Taryn M.; Irazola, Vilma; Huffman, Mark D.; et al.; Evaluating the World Health Organization’s Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala; Ubiquity Press; Global Heart; 20; 1; 1-2025; 1-17
2211-8160
2211-8179
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1397
info:eu-repo/semantics/altIdentifier/doi/10.5334/gh.1397
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Ubiquity Press
publisher.none.fl_str_mv Ubiquity Press
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.265058

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