Scaling up the primary health integrated care project for chronic conditions in Kenya: study protocol for an implementation research project.
Scaling up the primary health integrated care project for chronic conditions in Kenya: study protocol for an implementation research project.
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DOI：
10.1136/bmjopen-2021-056261
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发表时间：
2022-03-16
期刊：
影响因子：
2.9
通讯作者：
Perel P
中科院分区：
文献类型：
--
作者：
Nolte E;Kamano JH;Naanyu V;Etyang A;Gasparrini A;Hanson K;Koros H;Mugo R;Murphy A;Oyando R;Pliakas T;Were V;Willis R;Barasa E;Perel P
在患有非传染性疾病的人数不断增加的情况下，肯尼亚投资于加强初级保健，并努力扩大现有的服务提供平台，以纳入非传染性疾病护理。其中一种方法是肯尼亚西部的AMPATH（提供医疗保健的学术模式）模式，该模式为2018年启动的慢性病初级卫生综合保健项目（PIC 4C）提供了平台，以进一步加强预防和控制高血压，糖尿病，乳腺癌和宫颈癌的初级保健服务。本研究旨在了解PIC 4C如何实现其预期目标，并为肯尼亚非传染性疾病患者综合护理的PIC 4C模式提供信息和支持。这项研究是由一个概念框架的实施，维持和推广创新的卫生服务提供。本研究采用定性与定量相结合的多方法设计，包括：（1）对卫生工作者和决策者进行深入访谈，以探索PIC 4C的实施经验;（2）对糖尿病或高血压患者进行横断面调查和深入访谈，以了解PIC 4C如何满足患者的需求;（3）采用中断时间序列分析的队列研究，以评估PIC 4C导致健康益处的程度，例如改善对高血压或糖尿病的管理;以及（4）一项家庭队列研究，以检查国家医院保险慢性病护理包为PIC 4C内的高血压或糖尿病患者提供财务风险保护的程度。该研究已获得莫伊大学机构研究和伦理委员会（FAN：0003586）和伦敦卫生与热带医学学院（17940）的批准。与地方、县、国家和国际各级的主要利益攸关方举办讲习班，将确保及早广泛传播我们的调查结果，为扩大这一护理模式提供信息。我们还将在同行评审期刊上发表研究结果。
Amid the rising number of people with non-communicable diseases (NCDs), Kenya has invested in strengthening primary care and in efforts to expand existing service delivery platforms to integrate NCD care. One such approach is the AMPATH (Academic Model Providing Access to Healthcare) model in western Kenya, which provides the platform for the Primary Health Integrated Care Project for Chronic Conditions (PIC4C), launched in 2018 to further strengthen primary care services for the prevention and control of hypertension, diabetes, breast and cervical cancer. This study seeks to understand how well PIC4C delivers on its intended aims and to inform and support scale up of the PIC4C model for integrated care for people with NCDs in Kenya. The study is guided by a conceptual framework on implementing, sustaining and spreading innovation in health service delivery. We use a multimethod design combining qualitative and quantitative approaches, involving: (1) in-depth interviews with health workers and decision-makers to explore experiences of delivering PIC4C; (2) a cross-sectional survey of patients with diabetes or hypertension and in-depth interviews to understand how well PIC4C meets patients’ needs; (3) a cohort study with an interrupted time series analysis to evaluate the degree to which PIC4C leads to health benefits such as improved management of hypertension or diabetes; and (4) a cohort study of households to examine the extent to which the national hospital insurance chronic care package provides financial risk protection to people with hypertension or diabetes within PIC4C. The study has received approvals from Moi University Institutional Research and Ethics Committee (FAN:0003586) and the London School of Hygiene & Tropical Medicine (17940). Workshops with key stakeholders at local, county, national and international levels will ensure early and wide dissemination of our findings to inform scale up of this model of care. We will also publish findings in peer-reviewed journals.
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