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BACKGROUNDIncorporating social determinants of health into care delivery for chronic diseases is a priority.OBJECTIVESThe goal of this study was to evaluate the impact of group medical visits and/or microfinance on bloodpressure reduction.METHODSThe authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usualcare plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primaryoutcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used toevaluate the outcomes.RESULTSA total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF).Average baseline SBP was 157.5 mm Hg. Mean SBP declined 11.4, 14.8, 14.7, and 16.4 mm Hg in UC, MF, GMV, andGMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative toUC, SBP reduction was 3.9 mm Hg ( 8.5 to 0.7), 3.3 mm Hg ( 7.8 to 1.2), and 2.3 mm Hg ( 7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefitpoorer individuals. Active participation in GMV-MF was associated with greater benefit.CONCLUSIONSA strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led toclinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was notmet in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts rangingfrom substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery forchronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC];NCT02501746) (J Am Coll Cardiol 2021;77:2007–18) © 2021 by the American College of Cardiology Foundation. |
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