{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:13:06Z","timestamp":1747195986814,"version":"3.40.5"},"reference-count":102,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Little is known about the effects of the Chronic Care Model (CCM) and community health workers (CHWs) on pharmacotherapy of type 2 diabetes and hypertension in resource-poor settings. This retrospective cohort implementation study evaluated the effects of a community-based program consisting of CCM, CHWs, guidelines-based treatment protocols, and inexpensive freely accessible medications on type 2 diabetes and hypertension pharmacotherapy quality. A door-to-door household survey identified 856 adults 35 years of age and older living in a low-income Peruvian community, of whom 83% participated in screening for diabetes and hypertension. Patients with confirmed type 2 diabetes and\/or hypertension participated in the program\u2019s weekly to monthly visits for &lt; = 27 months. The program was implemented as two care periods employed sequentially. During home care, CHWs made weekly home visits and a physician made treatment decisions remotely. During subsequent clinic care, a physician attended patients in a centralized clinic. The study compared the effects of program (pre- versus post-) (N = 262 observations), and home versus clinic care periods (N = 211 observations) on standards of treatment with hypoglycemic and antihypertensive agents, angiotensin converting enzyme inhibitors, and low-dose aspirin. During the program, 80% and 50% achieved hypoglycemic and antihypertensive standards, respectively, compared to 35% and 8% prior to the program, RRs 2.29 (1.72\u20133.04, p &lt;0.001) and 6.64 (3.17\u201313.9, p&lt;0.001). Achievement of treatment standards was not improved by clinic compared to home care (RRs 1.0 +\/- 0.08). In both care periods, longer retention in care (&gt;50% of allowable time) was associated with achievement of all treatment standards. 85% compared to 56% achieved the hypoglycemic treatment standard with longer and shorter retention, respectively, RR 1.52 (1.13\u20132.06, p&lt;0.001); 56% compared to 27% achieved the antihypertensive standard, RR 2.11 (1.29\u20133.45, p&lt;0.001). In a dose-dependent manner, the community-based program was associated with improved guidelines-based pharmacotherapy of type 2 diabetes and hypertension.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003512","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T19:28:30Z","timestamp":1724354910000},"page":"e0003512","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A retrospective cohort study of a community-based primary care program\u2019s effects on pharmacotherapy quality in low-income Peruvians with type 2 diabetes and hypertension"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5067-9176","authenticated-orcid":true,"given":"John E.","family":"Deaver","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5714-6768","authenticated-orcid":true,"given":"Gabriela M.","family":"Uchuya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne R.","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet A.","family":"Foote","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"issue":"25","key":"pgph.0003512.ref001","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u20132019: Update From the GBD 2019 Study","volume":"76","author":"GA Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"10022","key":"pgph.0003512.ref002","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S0140-6736(15)01225-8","article-title":"Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis","volume":"387","author":"D Ettehad","year":"2016","journal-title":"Lancet"},{"issue":"7258","key":"pgph.0003512.ref003","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1136\/bmj.321.7258.412","article-title":"Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study","volume":"321","author":"AI Adler","year":"2000","journal-title":"BMJ (Clinical research ed)"},{"issue":"7258","key":"pgph.0003512.ref004","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1136\/bmj.321.7258.405","article-title":"Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study","volume":"321","author":"IM Stratton","year":"2000","journal-title":"BMJ (Clinical research ed)"},{"key":"pgph.0003512.ref005","volume-title":"IDF Diabetes Atlas","author":"International Diabetes Federation","year":"2021","edition":"1"},{"issue":"7","key":"pgph.0003512.ref006","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1161\/CIRCRESAHA.120.318729","article-title":"Hypertension in Low- and Middle-Income Countries","volume":"128","author":"AE Schutte","year":"2021","journal-title":"Circ Res"},{"issue":"4","key":"pgph.0003512.ref007","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1038\/s41581-019-0244-2","article-title":"The global epidemiology of hypertension","volume":"16","author":"KT Mills","year":"2020","journal-title":"Nat Rev Nephrol"},{"issue":"8","key":"pgph.0003512.ref008","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1007\/s00125-022-05713-6","article-title":"Low- and middle-income countries demonstrate rapid growth of type 2 diabetes: an analysis based on Global Burden of Disease 1990\u20132019 data","volume":"65","author":"J Liu","year":"2022","journal-title":"Diabetologia"},{"issue":"2","key":"pgph.0003512.ref009","doi-asserted-by":"crossref","first-page":"e060387","DOI":"10.1136\/bmjopen-2021-060387","article-title":"Health system readiness for non-communicable diseases at the primary care level: a systematic review","volume":"12","author":"A Kabir","year":"2022","journal-title":"BMJ Open"},{"issue":"14","key":"pgph.0003512.ref010","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1001\/jama.288.14.1775","article-title":"Improving primary care for patients with chronic illness","volume":"288","author":"T Bodenheimer","year":"2002","journal-title":"JAMA"},{"issue":"4","key":"pgph.0003512.ref011","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1136\/qshc.2004.010744","article-title":"Improving the quality of health care for chronic conditions","volume":"13","author":"JE Epping-Jordan","year":"2004","journal-title":"Qual Saf Health Care"},{"issue":"1","key":"pgph.0003512.ref012","first-page":"S10","article-title":"1. 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