Cargando…
Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal
Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care—first-contact access, care coordination, compre...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509610/ https://www.ncbi.nlm.nih.gov/pubmed/31139453 http://dx.doi.org/10.1136/bmjgh-2018-001343 |
_version_ | 1783417278002364416 |
---|---|
author | Kumar, Anirudh Schwarz, Dan Acharya, Bibhav Agrawal, Pawan Aryal, Anu Choudhury, Nandini Citrin, David Dangal, Binod Deukmedjian, Grace Dhimal, Meghnath Dhungana, Santosh Gauchan, Bikash Gupta, Tula Halliday, Scott Jha, Dhiraj Kalaunee, SP Karmacharya, Biraj Kishore, Sandeep Koirala, Bhagawan Kunwar, Lal Mahar, Ramesh Maru, Sheela Mehanni, Stephen Nirola, Isha Pandey, Sachit Pant, Bhaskar Pathak, Mandeep Poudel, Sanjaya Rajbhandari, Irina Raut, Anant Rimal, Pragya Schwarz, Ryan Shrestha, Archana Thapa, Aradhana Thapa, Poshan Thapa, Roshan Wong, Lena Maru, Duncan |
author_facet | Kumar, Anirudh Schwarz, Dan Acharya, Bibhav Agrawal, Pawan Aryal, Anu Choudhury, Nandini Citrin, David Dangal, Binod Deukmedjian, Grace Dhimal, Meghnath Dhungana, Santosh Gauchan, Bikash Gupta, Tula Halliday, Scott Jha, Dhiraj Kalaunee, SP Karmacharya, Biraj Kishore, Sandeep Koirala, Bhagawan Kunwar, Lal Mahar, Ramesh Maru, Sheela Mehanni, Stephen Nirola, Isha Pandey, Sachit Pant, Bhaskar Pathak, Mandeep Poudel, Sanjaya Rajbhandari, Irina Raut, Anant Rimal, Pragya Schwarz, Ryan Shrestha, Archana Thapa, Aradhana Thapa, Poshan Thapa, Roshan Wong, Lena Maru, Duncan |
author_sort | Kumar, Anirudh |
collection | PubMed |
description | Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care—first-contact access, care coordination, comprehensiveness and continuity—offer practical, high-quality design options for non-communicable disease care in low-income and middle-income countries. We describe an integrated non-communicable disease intervention in rural Nepal using the 4C principles. We present 18 months of retrospective assessment of implementation for patients with type II diabetes, hypertension and chronic obstructive pulmonary disease. We assessed feasibility using facility and community follow-up as proxy measures, and assessed effectiveness using singular ‘at-goal’ metrics for each condition. The median follow-up for diabetes, hypertension and chronic obstructive pulmonary disease was 6, 6 and 7 facility visits, and 10, 10 and 11 community visits, respectively (0.9 monthly patient touch-points). Loss-to-follow-up rates were 16%, 19% and 22%, respectively. The median time between visits was approximately 2 months for facility visits and 1 month for community visits. ‘At-goal’ status for patients with chronic obstructive pulmonary disease improved from baseline to endline (p=0.01), but not for diabetes or hypertension. This is the first integrated non-communicable disease intervention, based on the 4C principles, in Nepal. Our experience demonstrates high rates of facility and community follow-up, with comparatively low lost-to-follow-up rates. The mixed effectiveness results suggest that while this intervention may be valuable, it may not be sufficient to impact outcomes. To achieve the Sustainable Development Goals, further implementation research is urgently needed to determine how to optimise non-communicable disease interventions. |
format | Online Article Text |
id | pubmed-6509610 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65096102019-05-28 Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal Kumar, Anirudh Schwarz, Dan Acharya, Bibhav Agrawal, Pawan Aryal, Anu Choudhury, Nandini Citrin, David Dangal, Binod Deukmedjian, Grace Dhimal, Meghnath Dhungana, Santosh Gauchan, Bikash Gupta, Tula Halliday, Scott Jha, Dhiraj Kalaunee, SP Karmacharya, Biraj Kishore, Sandeep Koirala, Bhagawan Kunwar, Lal Mahar, Ramesh Maru, Sheela Mehanni, Stephen Nirola, Isha Pandey, Sachit Pant, Bhaskar Pathak, Mandeep Poudel, Sanjaya Rajbhandari, Irina Raut, Anant Rimal, Pragya Schwarz, Ryan Shrestha, Archana Thapa, Aradhana Thapa, Poshan Thapa, Roshan Wong, Lena Maru, Duncan BMJ Glob Health Practice Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care—first-contact access, care coordination, comprehensiveness and continuity—offer practical, high-quality design options for non-communicable disease care in low-income and middle-income countries. We describe an integrated non-communicable disease intervention in rural Nepal using the 4C principles. We present 18 months of retrospective assessment of implementation for patients with type II diabetes, hypertension and chronic obstructive pulmonary disease. We assessed feasibility using facility and community follow-up as proxy measures, and assessed effectiveness using singular ‘at-goal’ metrics for each condition. The median follow-up for diabetes, hypertension and chronic obstructive pulmonary disease was 6, 6 and 7 facility visits, and 10, 10 and 11 community visits, respectively (0.9 monthly patient touch-points). Loss-to-follow-up rates were 16%, 19% and 22%, respectively. The median time between visits was approximately 2 months for facility visits and 1 month for community visits. ‘At-goal’ status for patients with chronic obstructive pulmonary disease improved from baseline to endline (p=0.01), but not for diabetes or hypertension. This is the first integrated non-communicable disease intervention, based on the 4C principles, in Nepal. Our experience demonstrates high rates of facility and community follow-up, with comparatively low lost-to-follow-up rates. The mixed effectiveness results suggest that while this intervention may be valuable, it may not be sufficient to impact outcomes. To achieve the Sustainable Development Goals, further implementation research is urgently needed to determine how to optimise non-communicable disease interventions. BMJ Publishing Group 2019-04-29 /pmc/articles/PMC6509610/ /pubmed/31139453 http://dx.doi.org/10.1136/bmjgh-2018-001343 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Practice Kumar, Anirudh Schwarz, Dan Acharya, Bibhav Agrawal, Pawan Aryal, Anu Choudhury, Nandini Citrin, David Dangal, Binod Deukmedjian, Grace Dhimal, Meghnath Dhungana, Santosh Gauchan, Bikash Gupta, Tula Halliday, Scott Jha, Dhiraj Kalaunee, SP Karmacharya, Biraj Kishore, Sandeep Koirala, Bhagawan Kunwar, Lal Mahar, Ramesh Maru, Sheela Mehanni, Stephen Nirola, Isha Pandey, Sachit Pant, Bhaskar Pathak, Mandeep Poudel, Sanjaya Rajbhandari, Irina Raut, Anant Rimal, Pragya Schwarz, Ryan Shrestha, Archana Thapa, Aradhana Thapa, Poshan Thapa, Roshan Wong, Lena Maru, Duncan Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal |
title | Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal |
title_full | Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal |
title_fullStr | Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal |
title_full_unstemmed | Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal |
title_short | Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal |
title_sort | designing and implementing an integrated non-communicable disease primary care intervention in rural nepal |
topic | Practice |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509610/ https://www.ncbi.nlm.nih.gov/pubmed/31139453 http://dx.doi.org/10.1136/bmjgh-2018-001343 |
work_keys_str_mv | AT kumaranirudh designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT schwarzdan designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT acharyabibhav designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT agrawalpawan designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT aryalanu designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT choudhurynandini designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT citrindavid designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT dangalbinod designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT deukmedjiangrace designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT dhimalmeghnath designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT dhunganasantosh designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT gauchanbikash designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT guptatula designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT hallidayscott designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT jhadhiraj designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT kalauneesp designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT karmacharyabiraj designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT kishoresandeep designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT koiralabhagawan designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT kunwarlal designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT maharramesh designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT marusheela designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT mehannistephen designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT nirolaisha designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT pandeysachit designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT pantbhaskar designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT pathakmandeep designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT poudelsanjaya designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT rajbhandariirina designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT rautanant designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT rimalpragya designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT schwarzryan designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT shresthaarchana designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT thapaaradhana designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT thapaposhan designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT thaparoshan designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT wonglena designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal AT maruduncan designingandimplementinganintegratednoncommunicablediseaseprimarycareinterventioninruralnepal |