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Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda

BACKGROUND: Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised...

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Autores principales: Eberly, Lauren Anne, Rusangwa, Christian, Ng'ang'a, Loise, Neal, Claire C, Mukundiyukuri, Jean Paul, Mpanusingo, Egide, Mungunga, Jean Claude, Habineza, Hamissy, Anderson, Todd, Ngoga, Gedeon, Dusabeyezu, Symaque, Kwan, Gene, Bavuma, Charlotte, Rusingiza, Emmanual, Mutabazi, Francis, Mucumbitsi, Joseph, Gahamanyi, Cyprien, Mutumbira, Cadet, Park, Paul H, Mpunga, Tharcisse, Bukhman, Gene
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597643/
https://www.ncbi.nlm.nih.gov/pubmed/31321086
http://dx.doi.org/10.1136/bmjgh-2019-001449
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author Eberly, Lauren Anne
Rusangwa, Christian
Ng'ang'a, Loise
Neal, Claire C
Mukundiyukuri, Jean Paul
Mpanusingo, Egide
Mungunga, Jean Claude
Habineza, Hamissy
Anderson, Todd
Ngoga, Gedeon
Dusabeyezu, Symaque
Kwan, Gene
Bavuma, Charlotte
Rusingiza, Emmanual
Mutabazi, Francis
Mucumbitsi, Joseph
Gahamanyi, Cyprien
Mutumbira, Cadet
Park, Paul H
Mpunga, Tharcisse
Bukhman, Gene
author_facet Eberly, Lauren Anne
Rusangwa, Christian
Ng'ang'a, Loise
Neal, Claire C
Mukundiyukuri, Jean Paul
Mpanusingo, Egide
Mungunga, Jean Claude
Habineza, Hamissy
Anderson, Todd
Ngoga, Gedeon
Dusabeyezu, Symaque
Kwan, Gene
Bavuma, Charlotte
Rusingiza, Emmanual
Mutabazi, Francis
Mucumbitsi, Joseph
Gahamanyi, Cyprien
Mutumbira, Cadet
Park, Paul H
Mpunga, Tharcisse
Bukhman, Gene
author_sort Eberly, Lauren Anne
collection PubMed
description BACKGROUND: Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease. METHODS: A retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro District Hospital in rural Rwanda. We determined initial start-up and annual operating financial cost of the Butaro district advanced NCD clinic for the fiscal year 2013–2014. Per-patient annual cost by disease category was determined. RESULTS: A total of US$47 976 in fixed start-up costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300 000 people (US$0.16 per capita). The additional annual operating cost for this clinic was US$68 975 (US$0.23 per capita) to manage a 632-patient cohort and provide training, supervision and mentorship to primary health centres. Labour comprised 54% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient (US$151), followed by heart failure (US$104), driven primarily by medication therapy and laboratory testing. CONCLUSIONS: This is the first study to evaluate the costs of integrated, decentralised chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems.
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spelling pubmed-65976432019-07-18 Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda Eberly, Lauren Anne Rusangwa, Christian Ng'ang'a, Loise Neal, Claire C Mukundiyukuri, Jean Paul Mpanusingo, Egide Mungunga, Jean Claude Habineza, Hamissy Anderson, Todd Ngoga, Gedeon Dusabeyezu, Symaque Kwan, Gene Bavuma, Charlotte Rusingiza, Emmanual Mutabazi, Francis Mucumbitsi, Joseph Gahamanyi, Cyprien Mutumbira, Cadet Park, Paul H Mpunga, Tharcisse Bukhman, Gene BMJ Glob Health Research BACKGROUND: Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease. METHODS: A retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro District Hospital in rural Rwanda. We determined initial start-up and annual operating financial cost of the Butaro district advanced NCD clinic for the fiscal year 2013–2014. Per-patient annual cost by disease category was determined. RESULTS: A total of US$47 976 in fixed start-up costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300 000 people (US$0.16 per capita). The additional annual operating cost for this clinic was US$68 975 (US$0.23 per capita) to manage a 632-patient cohort and provide training, supervision and mentorship to primary health centres. Labour comprised 54% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient (US$151), followed by heart failure (US$104), driven primarily by medication therapy and laboratory testing. CONCLUSIONS: This is the first study to evaluate the costs of integrated, decentralised chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems. BMJ Publishing Group 2019-06-17 /pmc/articles/PMC6597643/ /pubmed/31321086 http://dx.doi.org/10.1136/bmjgh-2019-001449 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 Research
Eberly, Lauren Anne
Rusangwa, Christian
Ng'ang'a, Loise
Neal, Claire C
Mukundiyukuri, Jean Paul
Mpanusingo, Egide
Mungunga, Jean Claude
Habineza, Hamissy
Anderson, Todd
Ngoga, Gedeon
Dusabeyezu, Symaque
Kwan, Gene
Bavuma, Charlotte
Rusingiza, Emmanual
Mutabazi, Francis
Mucumbitsi, Joseph
Gahamanyi, Cyprien
Mutumbira, Cadet
Park, Paul H
Mpunga, Tharcisse
Bukhman, Gene
Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda
title Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda
title_full Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda
title_fullStr Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda
title_full_unstemmed Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda
title_short Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda
title_sort cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural rwanda
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597643/
https://www.ncbi.nlm.nih.gov/pubmed/31321086
http://dx.doi.org/10.1136/bmjgh-2019-001449
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