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Article Dans Une Revue BMJ Global Health Année : 2019

Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal

Anirudh Kumar
  • Fonction : Auteur
Dan Schwarz
  • Fonction : Auteur
Bibhav Acharya
  • Fonction : Auteur
Pawan Agrawal
  • Fonction : Auteur
Anu Aryal
  • Fonction : Auteur
Nandini Choudhury
  • Fonction : Auteur
Binod Dangal
  • Fonction : Auteur
Grace Deukmedjian
  • Fonction : Auteur
Meghnath Dhimal
  • Fonction : Auteur
Santosh Dhungana
  • Fonction : Auteur
Bikash Gauchan
  • Fonction : Auteur
Tula Gupta
  • Fonction : Auteur
Scott Halliday
  • Fonction : Auteur
Dhiraj Jha
  • Fonction : Auteur
Sp Kalaunee
  • Fonction : Auteur
Biraj Karmacharya
  • Fonction : Auteur
Sandeep Kishore
  • Fonction : Auteur
Bhagawan Koirala
  • Fonction : Auteur
Lal Kunwar
  • Fonction : Auteur
Ramesh Mahar
  • Fonction : Auteur
Sheela Maru
  • Fonction : Auteur
Stephen Mehanni
  • Fonction : Auteur
Isha Nirola
  • Fonction : Auteur
Sachit Pandey
  • Fonction : Auteur
Bhaskar Pant
  • Fonction : Auteur
Mandeep Pathak
  • Fonction : Auteur
Sanjaya Poudel
  • Fonction : Auteur
Irina Rajbhandari
  • Fonction : Auteur
Anant Raut
  • Fonction : Auteur
Pragya Rimal
  • Fonction : Auteur
Ryan Schwarz
  • Fonction : Auteur
Archana Shrestha
  • Fonction : Auteur
Aradhana Thapa
  • Fonction : Auteur
Poshan Thapa
  • Fonction : Auteur
Roshan Thapa
  • Fonction : Auteur
Lena Wong
  • Fonction : Auteur
Duncan Maru
  • Fonction : Auteur

Résumé

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. 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.

Dates et versions

hal-02309262 , version 1 (09-10-2019)

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Citer

Anirudh Kumar, Dan Schwarz, Bibhav Acharya, Pawan Agrawal, Anu Aryal, et al.. Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal. BMJ Global Health, 2019, 4 (2), pp.e001343. ⟨10.1136/bmjgh-2018-001343⟩. ⟨hal-02309262⟩
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