Strategies for Stakeholder Engagement and Uptake of New Intervention Experience From State-Wide Implementation of mHealth Technology for NCD Care in Tripura, India
Strategies for Stakeholder Engagement and Uptake of New Intervention Experience From State-Wide Implementation of mHealth Technology for NCD Care in Tripura, India
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DOI：
10.1016/j.gheart.2019.06.002
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发表时间：
2019-06-01
期刊：
影响因子：
3.7
通讯作者：
Tandon, Nikhil
中科院分区：
文献类型：
--
作者：
Jindal, Devraj;Roy, Ambuj;Tandon, Nikhil
背景资料：适当的策略和关键利益相关者的参与是成功实施新的医疗保健干预措施的关键。Objectives：本研究旨在阐明用于扩大以研究为基础的干预措施的关键策略，mPower心脏电子临床决策支持系统（e-CDSS），在特里普拉邦的卫生设施在全州范围内实施。在特里普拉邦政府卫生设施的非传染性疾病诊所，采用多种策略在全州范围内实施mPower Heart e-CDSS：成立一个技术协调兼支助股，改革管理，创造有利环境，调整以用户为重点的干预措施，并加强卫生信息系统。有效提供新的卫生系统干预措施需要多个层面的参与，包括政治领导人、卫生行政人员和卫生专业人员，这可以通过组建一个技术协调兼支助单位来实现。重要的是要明确现有人力的作用和责任，并提供结构化的培训计划。卫生设施的有利环境（提供基本设备、空间和时间等）也至关重要。成功实施还需要患者、卫生保健提供者、卫生系统和领导层认识到新干预措施的直接和长期效益，并接受干预措施。在行政当局的不断鼓励和推动下，通过采用多种战略，40个政府保健设施采用了mPower Heart e-CDSS。从2017年5月启动到2018年11月20日，共有100，810名符合条件的人接受了筛选和入组，其中35，884人接受了高血压治疗，9，698人接受了糖尿病治疗，5，527人同时接受了高血压和糖尿病治疗。结论：基于实施原则的多种策略是成功扩大基于研究的干预措施的必要条件。
Background: Appropriate strategies and key stakeholder engagement are the keys to successful implementation of new health care interventions.Objectives: The study sought to articulate the key strategies used for scaling up a research-based intervention, mPower Heart electronic Clinical Decision Support System (e-CDSS), for state-wide implementation at health facilities in Tripura.Methods: Multiple strategies were used for statewide implementation of mPower Heart e-CDSS at noncommunicable diseases clinics across the government health facilities in Tripura: formation of a technical coordination-cum-support unit, change management, enabling environment, adapting the intervention with user focus, and strengthening the Health Information System.Results: The effective delivery of a new health system intervention requires engagement at multiple levels including political leadership, health administrators, and health professionals, which can be achieved by forming a technical coordination-cum-support unit. It is important to specify the role and responsibilities of existing manpower and provide a structured training program. Enabling environment at health facilities (providing essential equipment, space and time, etc.) is also crucial. Successful implementation also requires that patients, health care providers, the health system, and leadership recognize the immediate and long-term benefits of the new intervention and have a buy-in in the intervention. With constant encouragement and nudge from administrative authorities and by using multiple strategies, 40 government health facilities adopted the mPower Heart e-CDSS. From its launch in May 2017 until November 20, 2018, a total of 100,810 eligible individuals were screened and enrolled, with 35,884 treated for hypertension, 9,698 for diabetes, and 5,527 for both hypertension and diabetes.Conclusions: Multiple strategies, based on implementation principles, are required for successful scaling up of research-based interventions.