Assessing costs of a hypertension management program: An application of the HEARTS costing tool in a program planning workshop in Thailand

The HEARTS technical package, a part of the Global Hearts Initiative to improve cardiovascular health globally, is a strategic approach for cardiovascular disease prevention and control at the primary care level. To support the evaluation of costs associated with HEARTS program components, a costing tool was developed to evaluate the incremental cost of program implementation. This report documents an application of the HEARTS costing tool during a costing workshop prior to the initiation of a HEARTS pilot program in Thailand's Phothong District, 2019‐2020. During the workshop, a mock exercise was conducted to estimate the expected costs of the pilot study. The workshop application of the tool underscored its applicability to the HEARTS program planning process by identifying cost drivers associated with individual program elements. It further illustrated that by supporting disaggregation of costs into fixed and variable categories, the tool can inform the scalability of pilot projects to larger populations. Lessons learned during the initial development and application of the costing tool can inform future HEARTS evaluation efforts.     

Hospital‐based intervention to enhance hypertension diagnosis in Kalasin hospital,Thailand, 2017‐2019: A pre‐post pilot intervention study

In Thailand 5.9 million individuals ≥15 years old have undiagnosed hypertension. The intervention to reduce undiagnosed hypertension was piloted and aimed to compare pre‐ and post‐intervention hypertension diagnosis rate and follow‐up rate. A hospital‐based pre‐ and post‐intervention study was piloted in a general hospital in Thailand. The intervention included an electronic pop‐up alert when raised blood pressure was observed and a follow‐up protocol. The follow‐up protocol entered patient information in a follow‐up book that scheduled an appointment to recheck blood pressure. Statistical analyses compared the rate of hypertension diagnosis and follow‐up between the pre‐ and post‐intervention periods, adjusted for differences in baseline characteristics. A post‐intervention, self‐report survey among nurses and nurse‐aids explored perceptions about raised blood pressure management and solicited suggestions to improve the intervention. 574 raised blood pressure patients visited the hospital in the pre‐intervention period; 27.4% returned for follow‐‐up; and hypertension diagnosis rate was 1.4%. Among 686 post‐intervention raised blood pressure patients, overall hypertension diagnosis rate improved to 6.1%. In per‐protocol patients, 81.9% were booked to follow‐‐up, hypertension diagnosis rate was 18.6%, and the adjusted odds ratio of hypertension diagnosis was 4.5 times higher compared with the pre‐intervention period. By self‐report, 20% of health workers had no time to provide the follow‐up book due to work overload, yet >57% reported that information technology improved detection of raised blood pressure and improved follow‐up. The interventions significantly increased the hypertension diagnosis rate and follow‐up among raised blood pressure patients in a single hospital but may benefit from incorporating an information technology‐assisted follow‐up protocol.