Contextual and Landscape Analysis of Team-Based Care Practices for Hypertension Management in Ghana: A Cross-Sectional Nationwide Study

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ABSTRACT Introduction The World Health Organization recommends team-based care (TBC) for hypertension control, particularly in low-resourced settings. This study assessed current practices, task distribution, and perspectives on a team-based approach to hypertension management in Ghana. Methods In this cross-sectional study, we used convenience sampling to disseminate an online Resolve to Save Lives Survey (RTSL) to healthcare workers (HCWs) involved in hypertension management. Hypertension task-complexity was conceptualized (administrative, basic, and advanced clinical tasks) based on the Team-Based Hypertension Care conceptual framework and stratified by HCWs and facility-level characteristics. Results Among 345 HCWs, the mean age was 34 (±6.3), 58% were males, and 48% practiced in urban centers. Clinical task performance varies by setting, level of care, and education. Most administrative tasks were performed by non-clinicians (69%) and community health workers (14%). Basic clinical tasks were team-based, shared among nurses, pharmacists, and physician assistants. Nearly all advanced tasks were handled by physicians (28%) and physician assistants (43%). Major barriers to TBC included limited scope-of-practice laws (79%), inadequate training of non-physician workers (74%), opposition by physicians (62%), resistance by patients (57%), and opposition by nurses (43%). Utilization of treatment algorithms (96%), m-health technology (93%), and adequate HCW compensation (79%) were notable facilitators. Conclusions With dire shortages of physicians, strengthening the capacity of non- physician HCWs to perform advanced clinical tasks is essential for effective hypertension care in Ghana. Policies are needed to support training, expanded scope of practice, and regulatory reform to advance team-based care.

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