Multimorbidity-associated emergency hospital admissions: a "screen and link" strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol.

Autor:	Spencer SA; Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK., Rutta A; Kilimanjaro Clinical Research Institute, Moshi, Tanzania., Hyuha G; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Banda GT; Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK., Choko A; Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi., Dark P; Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, England, UK., Hertz JT; Duke University School of Medicine, Duke University, Durham, North Carolina, USA., Mmbaga BT; Kilimanjaro Clinical Research Institute, Moshi, Tanzania., Mfinanga J; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Mijumbi R; Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi., Muula A; The Kamuzu University of Health Sciences, Blantyre, Malawi., Nyirenda M; The Kamuzu University of Health Sciences, Blantyre, Malawi., Rosu L; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK., Rubach M; Kilimanjaro Clinical Research Institute, Moshi, Tanzania.; Duke University School of Medicine, Duke University, Durham, North Carolina, USA., Salimu S; Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK., Sakita F; Kilimanjaro Clinical Research Institute, Moshi, Tanzania.; Kilimanjaro Christian Medical University College, Moshi, Tanzania., Salima C; Achikondi Women Community Clinic, Lilongwe, Malawi., Sawe H; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Simiyu I; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK.; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Taegtmeyer M; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK., Urasa S; Kilimanjaro Clinical Research Institute, Moshi, Tanzania.; Kilimanjaro Christian Medical University College, Moshi, Tanzania., White S; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK., Yongolo NM; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK.; Kilimanjaro Clinical Research Institute, Moshi, Tanzania., Rylance J; Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK., Morton B; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK., Worrall E; Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, England, UK., Limbani F; Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
Jazyk:	angličtina
Zdroj:	NIHR open research [NIHR Open Res] 2024 Jan 18; Vol. 4, pp. 2. Date of Electronic Publication: 2024 Jan 18 (Print Publication: 2024).
DOI:	10.3310/nihropenres.13512.1
Abstrakt:	Background: The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub-Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Primary Objectives: Clinical: Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Secondary Objectives: Clinical: Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. Methods: This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng'ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways. Competing Interests: No competing interests were disclosed. (Copyright: © 2024 Spencer SA et al.)
Databáze:	MEDLINE
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