Management of diabetes and associated costs in a complex humanitarian setting in the Democratic Republic of Congo: a retrospective cohort study
Management of diabetes and associated costs in a complex humanitarian setting in the Democratic Republic of Congo: a retrospective cohort study
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DOI：
10.1136/bmjopen-2019-030176
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发表时间：
2019-11-01
期刊：
影响因子：
2.9
通讯作者：
Roberts, Bayard
中科院分区：
文献类型：
--
作者：
Ansbro, Eimhin Mary;Biringanine, Michel;Roberts, Bayard
目的评价刚果北基伍省复杂人道主义环境下的医院门诊部糖尿病综合门诊（IDC-OPD）。具体目标是：（1）分析糖尿病中期临床和方案结果（2）探讨关键不安全性和相关计划事件与这些结果的关联;（3）描述增量IDC-OPD计划成本。设计对2014年1月至2017年2月收集的常规计划数据进行回顾性队列分析; 2014/2015年计划成本分析。设置无国界医生组织支持的刚果北基伍省Mweso医院门诊糖尿病计划。参与者糖尿病患者参加IDC-OPD。结果测量中间临床和计划结果趋势结果：243例糖尿病患者中，44.6%为女性，中位年龄为45岁（IQR 32-56）; 51.4%为2型糖尿病。引入IDC-OPD后，血糖控制改善，患者数量和访视间隔增加。在不安全期间，控制率最初由护士提供，缩减服务，而病人数量和访问间隔减少。由于药物缺货而暂停服务后，患者不太可能达到控制，恢复服务后情况有所改善。总成本从2014年（（原文如此）36 573）下降到2015年（原文如此）30 861）16%。由于供应成本降低和患者数量增加，每位患者的年度成本从2014年的（原文如此）475降至2015年的（原文如此）214。结论在慢性冲突环境中，我们记录了在稳定时期控制糖尿病中间结果是可以实现的。在不安全时期，一个简化的，护士主导的模式保持控制率，直到药品缺货发生。在低收入环境中，每位患者每年的增量成本低于慢性艾滋病毒护理成本。未来的业务研究应确定一个简化的糖尿病护理包，包括应急准备。
Objective We aimed to evaluate an Integrated Diabetic Clinic within a Hospital Outpatient Department (IDC-OPD) in a complex humanitarian setting in North Kivu, Democratic Republic of Congo. Specific objectives were to: (1) analyse diabetes intermediate clinical and programmatic outcomes (blood pressure (BP)/glycaemic control, visit volume and frequency); (2) explore the association of key insecurity and related programmatic events with these outcomes; and (3) describe incremental IDC-OPD programme costs.Design Retrospective cohort analysis of routine programmatic data collected from January 2014 to February 2017; analysis of programme costs for 2014/2015.Setting Outpatient diabetes programme in Mweso hospital, supported by Medecins sans Frontieres, in North Kivu, Demographic Republic of Congo.Participants Diabetes patients attending IDC-OPD.Outcome measures Intermediate clinical and programmatic outcome trends (BP/ glycaemic control; visit volume/frequency); incremental programme costs.Results Of 243 diabetes patients, 44.6% were women, median age was 45 (IQR 32-56); 51.4% were classified type 2. On introduction of IDC-OPD, glucose control improved and patient volume and visit interval increased. During insecurity, control rates were initially maintained by a nurse-provided, scaled-back service, while patient volume and visit interval decreased. Following service suspension due to drug stock-outs, patients were less likely to achieve control, improving on service resumption. Total costs decreased 16% from 2014 ((sic)36 573) to 2015 ((sic)30 861). Annual cost per patient dropped from (sic)475 in 2014 to (sic)214 in 2015 due to reduced supply costs and increased patient numbers.Conclusions In a chronic conflict setting, we documented that control of diabetes intermediate outcomes was achievable during stable periods. During insecure periods, a simplified, nurse-led model maintained control rates until drug stock-outs occurred. Incremental per patient annual costs were lower than chronic HIV care costs in low-income settings. Future operational research should define a simplified diabetes care package including emergency preparedness.