Examinando por Autor "DiPette, Donald J."

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  • Publicación
    Restringido
    Fixed-dose combination pharmacologic therapy to improve hypertension control worldwide : Clinical perspective and policy implications
    (Journal of Clinical Hypertension, 2019, 2019) Lopez-Jaramillo, Patricio; Skeete, Jamario; Ridley Pharm, Emily; Campbell, Norm R. C.; Kishore, Sandeep P.; Jaffe, Marc G.; Coca, Antonio; Townsend, Raymond R.; Ordunez, Pedro; DiPette, Donald J.
  • Publicación
    Acceso abierto
    Mapping stages, barriers and facilitators to the implementation of HEARTS in the Americas initiative in 12 countries. A qualitative study
    (The JCH The Journal of Clinical Hypertension, 2021-03-18) Giraldo, Gloria P.; Joseph, Kristy T.; Angell, Sonia Y.; Campbell, Norm R. C.; Connell, Kenneth; DiPette, Donald J.; Escobar, Maria C.; Valdés-Gonzalez, Yamile; Jaffe, Marc G.; Malcolm, Taraleen; Maldonado, Javier; Lopez-Jaramillo, Patricio; Olsen, Michael H.; Ordunez, Pedro; Masira
    The World Health Organization (WHO) Global Hearts Initiative offers technical packages to reduce the burden of cardiovascular diseases through population-wide and targeted health services interventions. The Pan American Health Organization (PAHO) has led implementation of the HEARTS in the Americas Initiative since 2016. The authors mapped the developmental stages, barriers, and facilitators to implemen-tation among the 371 primary health care centers in the participating 12 countries. The authors used the qualitative method of document review to examine cumula-tive country reports, technical meeting notes, and reports to regional stakeholders. Common implementation barriers include segmentation of health systems, overcom-ing health care professionals' scope of practice legal restrictions, and lack of health information systems limiting operational evaluation and quality improvement mecha-nisms. Main implementation facilitators include political support from ministries of health and leading scientific societies, PAHO's role as a regional catalyst to implemen-tation, stakeholder endorsement demonstrated by incorporating HEARTS into official documents, and having a health system oriented to primary health care. Key lessons include the need for political commitment and cultivating on-the-ground leadership to initiate a shift in hypertension care delivery, accompanied by specific progress in the development of standardized treatment protocols and a set of high-quality medicines. By systematizing an implementation strategy to ease integration of interventions into delivery processes, the program strengthened technical leadership and ensured sus-tainability. These study findings will aid the regional approach by providing a staged planning model that incorporates lessons learned. A systematic approach to imple-mentation will enhance equity, efficiency, scale-up, and sustainability, and ultimately improve population hypertension control.
  • Publicación
    Acceso abierto
    Standardized treatment to improve hypertension control in primary health care: The HEARTS in the Americas Initiative
    (The JCH, The Journal of Clinical Hypertension, 2020-10-22) DiPette, Donald J.; Goughnour, Kenneth; Zuniga, Eric; Skeete, Jamario; Ridley, Emily; Angell, Sonia; Brettler, Jeffrey; Campbell, Norm R. C.; Coca, Antonio; Connell, Kenneth; Doon, Rohit; Jaffe, Marc; Lopez-Jaramillo, Patricio; Moran, Andrew; Orias, Marcelo; Pineiro, Daniel J.; Rosende, Andres; Valdes Gonzalez, Yamile; Ordunez, Pedro; Masira
    Hypertension is the leading risk factor for cardiovascular disease (CVD) worldwide. Despite the availability of effective antihypertensive medications, the control of hypertension at a global level is dismal, and consequently, the CVD burden continues to increase. In response, countries in Latin America and the Caribbean are implementing the HEARTS in the Americas, a community-based program that focuses on increasing hypertension control and CVD secondary prevention through risk factor mitigation. One key pillar is the implementation of a standardized hypertension treatment protocol supported by a small, high-quality formulary. This manuscript describes the methodology used by the HEARTS in the Americas program to implement a population-based standardized hypertension treatment protocol. It is rooted in a seamless transition from existing treatment practices to best practice using pharmacologic protocols built around a core set of ideal antihypertensive medications. In alignment with recent major hypertension guidelines, the HEARTS in the Americas protocols call for the rapid control of blood pressure, through the use of two antihypertensive medications, preferably in the form of a single pill, fixed-dose combination, in the initial treatment of hypertension. To date, the HEARTS in the Americas program has seen the improvement in antihypertensive medication formularies and the establishment of pharmacologic treatment protocols tailored to individual participating countries. This has translated to significant increases in hypertension control rates post-program implementation in these jurisdictions. Thus, the HEARTS in the Americas program could serve as a model, for not only the Americas Region but globally, and ultimately decrease the burden of CVD.