Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya
Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya
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DOI：
10.1007/s11606-016-3918-5
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发表时间：
2017-05-01
影响因子：
5.7
通讯作者：
Laktabai, Jeremiah
中科院分区：
文献类型：
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作者：
Pastakia, Sonak D.;Manyara, Simon M.;Laktabai, Jeremiah
背景：撒哈拉以南非洲(SSA)的农村地区一直报告非传染性疾病(NCD)治疗项目参与率低，结果不佳。本研究的目的是评估以患者为中心的农村NCD护理提供模式的影响，该模式被称为通过团体综合护理(BIGPIC)桥接收入产生(BIGPIC)。这项研究前瞻性地跟踪了筛查活动参与者的参与度和健康结果，并将关联频率与历史对照组进行比较。参加自愿NCD筛查活动的肯尼亚农村参与者被纳入BIGPIC护理模式。BIGPIC模式利用了一种情景提供护理模式，旨在解决农村环境中面临的独特障碍。该模型强调以下步骤：(1)在社区中寻找患者，(2)与同行/小额信贷团体建立联系，(3)整合教育，(4)在社区进行治疗，(5)增强经济可持续性，(6)通过激励产生护理需求。主要结果是联系频率，衡量高血压和/或糖尿病筛查呈阳性后返回护理的患者的百分比。次要指标包括保留频率，即在9个月的随访期内仍在接受护理的患者的百分比，以及在12个月内收缩压(SBP)、舒张压(DBP)和血糖的变化。在接受筛查的879人中，14.2%的人被确认患有高血压，而只有1.4%的人被确认患有糖尿病。实施与小额信贷挂钩的、以社区为基础的团体护理综合模式后，72.4%的筛查阳性参与者返回接受后续护理，其中70.3%在评估期的12个月期间仍在接受护理。仍在接受护理的患者表现出统计上显著的SBP[95%CI(13.9至28.4)，P<；0.01]和DBP[95%CI(1.4至7.6)，P<；0.01]的平均下降。根据农村SSA参与者的独特需求建立的情景护理提供模式的实施，在与护理和降压的联系方面有了统计学上的显著改善。
BACKGROUND: Rural settings in Sub-Saharan Africa (SSA) consistently report low participation in non-communicable disease (NCD) treatment programs and poor outcomes.The objective of this study is to assess the impact of the implementation of a patient-centered rural NCD care delivery model called Bridging Income Generation through grouP Integrated Care (BIGPIC).The study prospectively tracked participation and health outcomes for participants in a screening event and compared linkage frequencies to a historical comparison group.Rural Kenyan participants attending a voluntary NCD screening event were included within the BIGPIC model of care.The BIGPIC model utilizes a contextualized care delivery model designed to address the unique barriers faced in rural settings. This model emphasizes the following steps: (1) find patients in the community, (2) link to peer/microfinance groups, (3) integrate education, (4) treat in the community, (5) enhance economic sustainability and (6) generate demand for care through incentives.The primary outcome is the linkage frequency, which measures the percentage of patients who return for care after screening positive for either hypertension and/or diabetes. Secondary measures include retention frequencies defined as the percentage of patients remaining engaged in care throughout the 9-month follow-up period and changes in systolic (SBP) and diastolic blood pressure (DBP) and blood sugar over 12 months.Of the 879 individuals who were screened, 14.2 % were confirmed to have hypertension, while only 1.4 % were confirmed to have diabetes. The implementation of a comprehensive microfinance-linked, community-based, group care model resulted in 72.4 % of screen-positive participants returning for subsequent care, of which 70.3 % remained in care through the 12 months of the evaluation period. Patients remaining in care demonstrated a statistically significant mean decline of 21 mmHg in SBP [95 % CI (13.9 to 28.4), P < 0.01] and 5 mmHg drop in DBP [95 % CI (1.4 to 7.6), P < 0.01].The implementation of a contextualized care delivery model built around the unique needs of rural SSA participants led to statistically significant improvements in linkage to care and blood pressure reduction.