Decentralising NCD management in rural southern Africa: evaluation of a pilot implementation study

Autor: Callum Pierce, Ashley Sharp, Muhindo Kalungero, John Walley, Futhi Ndzinisa, David McConalogue, Nick Riches, Philip Daniels, Valephi Okello, Sweetness N Ntshalintshali, Paul M. Southworth, Annastesia Mims, Ekta Elston
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Hospitals
Rural
Psychological intervention
Pilot Projects
Decentralisation
Health Services Accessibility
03 medical and health sciences
Young Adult
0302 clinical medicine
Health care
Epidemiology
medicine
Humans
030212 general & internal medicine
Noncommunicable Diseases
Health service development
Aged
Aged
80 and over
Practice Patterns
Nurses'
NCD
Shared care
business.industry
lcsh:Public aspects of medicine
030503 health policy & services
Public health
Diabetes
Public Health
Environmental and Occupational Health
lcsh:RA1-1270
Non-communicable disease
Middle Aged
medicine.disease
Health Planning
Family medicine
Hypertension
Feasibility Studies
Observational study
Female
Health Services Research
Rural Health Services
Biostatistics
Swaziland
0305 other medical science
business
Eswatini
Research Article
Zdroj: BMC Public Health
BMC PUBLIC HEALTH
BMC Public Health, Vol 20, Iss 1, Pp 1-8 (2020)
ISSN: 1471-2458
Popis: Background The prevalence of non-communicable diseases, and associated morbidity and mortality, is increasing rapidly in low and middle-income countries where health systems often have limited access and lower quality of care. The intervention was to decentralise uncomplicated non-communicable disease (NCD) care from a hospital to nurse practitioners in health centres in a poor rural district in Eswatini, southern Africa. The objective of this study was to assess the feasibility and impact of decentralised care for NCDs within nurse-led clinics in order improve access and inform healthcare planning in Eswatini and similar settings. Methods In collaboration with the Eswatini Ministry of Health, we developed and implemented a package of interventions to support nurse-led delivery of care, including: clinical desk-guide for hypertension and diabetes, training modules, treatment cards and registries and patient leaflets. Ten community clinics in the Lubombo Region of Eswatini were randomly selected to be trained to deliver NCD care for a period of 18 months. Observational data on follow-up rates, blood pressure (BP), glucose etc. were recorded and evaluated. We compared blood pressure and blood glucose measurements between the first and fourth visits and fitted a linear mixed effects model. Results One thousand one hundred twenty-five patients were recruited to the study. Of these patients, 573 attended for at least 4 appointments. There was a significant reduction in mean BP among hypertensive patients after four visits of 9.9 mmHg systolic and 4.7 mmHg diastolic (p = 0.01), and a non-significant reduction in fasting blood glucose among diabetic patients of 1.2 mmol/l (p = 0.2). Key components of NCD care were completed consistently by nurses throughout the intervention period, including a trend towards patients progressing from monotherapy to dual therapy in accordance with prescribing guidelines. Conclusions The findings suggest that management of diabetes and hypertension care in a rural district setting can be safely delivered by nurses in community clinics according to a shared care protocol. Improved access is likely to lead to improved patient compliance with treatment.
Databáze: OpenAIRE
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