Implementation Outcomes of an Intervention to Improve Myocardial Infarction Care in Tanzania.
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2025-01
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Background: Uptake of evidence-based care for acute myocardial infarction (AMI) is limited in Tanzania. To address this, a tailored intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), was co-designed by an interdisciplinary team. Objectives: To determine implementation outcomes from a pilot trial of the MIMIC intervention in a Tanzanian emergency department (ED). Methods: The MIMIC intervention was implemented by the ED staff for one year. Fidelity, penetration, and costs were observed for each of the intervention components: designated champions to audit care, an online training module for staff, a triage card for nurses to flag patients with AMI symptoms, pocket cards summarizing AMI management for physicians, and an educational pamphlet for patients. Thirty days following enrollment, patient participants were contacted via telephone to inquire whether they had read the pamphlet. Results: Physician champions and nurse champions were actively engaged in the intervention across the twelve-month study period. Fidelity to the pocket card was excellent, with all 22 (100%) physicians observed to have ever brought their pocket cards to work, and penetration across physician-shifts was 96.1% (1835/1910). The training module was started by 20 out of the 22 (91%) physicians and 25 of the 32 (78%) nurses observed. Penetration, measured by module completion, was the same for physicians (20 of 22, 91%) but lower among nurses (21 of 32, 65.6%). Triage cards were used for 453 out of the 577 (78.5%) patients with chest pain or dyspnea. Fidelity to patients with AMI receiving the educational pamphlet was 37.6% (53 of 141). Only 22 of the 39 (56%) surviving AMI patients who received the pamphlet reported reading it, with most of the rest reporting being unaware that they had received it. The total annual cost of the MIMIC intervention was USD 1324.24. Conclusions: There was high variability in fidelity and penetration of the individual intervention components. Future studies should explore reasons for incomplete penetration and analyze cost-effectiveness for scale-up efforts across Tanzania.
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Hertz, Julian T, Francis M Sakita, Zaheer Rik Munshi, Faraan O Rahim, Daniel Mganga, Arafa Kachenje, James J Munisi, Abigail S Pyne, et al. (2025). Implementation Outcomes of an Intervention to Improve Myocardial Infarction Care in Tanzania. Annals of global health, 91(1). p. 43. 10.5334/aogh.4651 Retrieved from https://hdl.handle.net/10161/33990.
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Julian T Hertz
Julian Hertz, MD, MSc, is an Associate Professor of Emergency Medicine & Global Health. He graduated summa cum laude from Princeton University and attended medical school at Duke University, where he received the Dean's Merit Scholarship and the Thomas Jefferson Award for leadership. He completed his residency training in emergency medicine at Vanderbilt University Medical Center and his fellowship in Global Health at Duke.
Dr. Hertz's primary interests include global health, implementation science, and undergraduate and graduate medical education. Dr. Hertz's research focuses on using implementation science methods to improve cardiovascular care both locally and globally. His current projects involve developing interventions to improve acute myocardial infarction care in Tanzania, to improve management of hypertension among Tanzanians with HIV, and to improve post-hospital care among patients with multimorbidity in East Africa.
Dr. Hertz has received numerous awards for clinical, educational, and research excellence, including the Duke Emergency Medicine Faculty Teacher of the Year Award, the Duke Emergency Medicine Faculty Clinician of the Year Award, and the Duke Emergency Medicine Faculty Researcher of the Year Award. He has also received the Golden Apple Teaching Award from the Duke medical student body, the Duke Master Clinician/Teacher Award, and the Global Academic Achievement Award from the Society of Academic Emergency Medicine.
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
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