Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: a cluster-randomised trial
Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: a cluster-randomised trial
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DOI：
10.1111/j.1365-3156.2011.02827.x
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发表时间：
2011-10-01
影响因子：
3.3
通讯作者：
Stoll, Beat
中科院分区：
文献类型：
--
作者：
Labhardt, Niklaus D.;Balo, Jean-Richard;Stoll, Beat
目的比较低水平的设施为基础的干预措施对心血管（CV）疾病的患者保留率的任务转移和护士为主导的护理在农村卫生districts in Central Cameroon.METHODS的环境本研究是一项开放标签，三臂，集群随机试验在护士为主导的设施。所有三组都实施了治疗合同。对照组（第1组）不进行额外干预，第2组每4个月定期随访一次，给予1个月的免费治疗，第3组在错过随访的情况下收到提醒信。主要结局为1年时患者保留。次要结局是随访方案的依从性以及血压（BP）和血糖水平的变化。回顾性计算患者每月的药物和交通费用。结果共纳入33个中心和221例患者。1年后，109例患者（49.3%）仍留在该计划中。第2组和第3组的保留率分别为60%和65%，对照组为29%。干预组与对照组比较差异有统计学意义（P < 0.001），两干预组比较差异无统计学意义（P = 0.719）。研究组中保留患者之间的血压或空腹血糖趋势没有显着差异。患者每月平均抗高血压药物费用为（原文如此）1.1 +/- 0.9，糖尿病患者为（原文如此）1.2 +/- 1.1。高血压患者前往中心的平均交通成本为（原文如此）1.1 +/- 1.0，糖尿病患者为（原文如此）1.1 +/- 1.6。结论适合任务转移和护士主导护理环境且需要最少额外资源的低成本干预措施可以显着提高非洲农村CV疾病管理的保留率。治疗合同和在错过预约的情况下的提醒信相结合，是留住病人的有效措施。
OBJECTIVE To compare the effects of low-level facility-based interventions on patient retention rates for cardiovascular (CV) disease in an environment of task shifting and nurse-led care in rural health districts in Central Cameroon.METHODS This study is an open-label, three-arm, cluster-randomised trial in nurse-led facilities. All three groups implemented a treatment contract. The control group (group 1) had no additional intervention, group 2 received the incentive of 1 month of free treatment every forth month of regularly respected visits, and group 3 received reminder letters in case of a missed follow-up visit. The primary outcome was patient retention at 1 year. Secondary outcomes were adherence to follow-up visit schemes and changes in blood pressure (BP) and blood glucose levels. Patients' monthly spending for drugs and transport was calculated retrospectively.RESULTS A total of 33 centres and 221 patients were included. After 1 year, 109 patients (49.3%) remained in the programme. Retention rates in groups 2 and 3 were 60% and 65%, respectively, against 29% in the control group. The differences between the intervention groups and the control group were significant (P < 0.001), but differences between the two intervention groups were not (P = 0.719). There were no significant differences in BP or fasting plasma glucose trends between retained patients in the study groups. Average monthly cost to patients for antihypertensive medication was (sic) 1.1 +/- 0.9 and for diabetics (sic) 1.2 +/- 1.1. Transport costs to the centres were on average (sic) 1.1 +/- 1.0 for hypertensive patients and (sic) 1.1 +/- 1.6 for patients with diabetes.CONCLUSIONS Low-cost interventions suited to an environment of task shifting and nurse-led care and needing minimal additional resources can significantly improve retention rates in CV disease management in rural Africa. The combination of a treatment contract and reminder letters in case of missed appointments was an effective measure to retain patients in care.