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首页> 外文期刊>BMC Health Services Research >Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years
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Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years

机译：任务转移给喀麦隆农村地区高血压和糖尿病的综合管理的非内科临床医生：一项为期两年的计划评估

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Background The burden of non-communicable chronic diseases, such as hypertension and diabetes, increases in sub-Saharan Africa. However, the majority of the rural population does still not have access to adequate care. The objective of this study is to examine the effectiveness of integrating care for hypertension and type 2 diabetes by task shifting to non-physician clinician (NPC) facilities in eight rural health districts in Cameroon. Methods Of the 75 NPC facilities in the area, 69 (87%) received basic equipment and training in hypertension and diabetes care. Effectiveness was assessed after two years on status of equipment, knowledge among trained NPCs, number of newly detected patients, retention of patients under care, treatment cost to patients and changes in blood pressure (BP) and fasting plasma glucose (FPG) among treated patients. Results Two years into the programme, of 54 facilities (78%) available for re-assessment, all possessed a functional sphygmomanometer and stethoscope (65% at baseline); 96% stocked antihypertensive drugs (27% at baseline); 70% possessed a functional glucose meter and 72% stocked oral anti-diabetics (15% and 12% at baseline). NPCs' performance on multiple-choice questions of the knowledge-test was significantly improved. During a period of two years, trained NPCs initiated treatment for 796 patients with hypertension and/or diabetes. The retention of treated patients at one year was 18.1%. Hypertensive and diabetic patients paid a median monthly amount of 1.4 and 0.7 Euro respectively for their medication. Among hypertensive patients with ≥ 2 documented visits (n = 493), systolic BP decreased by 22.8 mmHg (95% CI: -20.6 to -24.9; p Conclusions The integration of hypertension and diabetes into primary health care of NPC facilities in rural Cameroon was feasible in terms of equipment and training, accessible in terms of treatment cost and showed promising BP- and FPG-trends. However, low case-detection rates per NPC and a very high attrition among patients enrolled into care, limited the effectiveness of the programme.
机译：背景技术在撒哈拉以南非洲，非传染性慢性病（例如高血压和糖尿病）的负担增加。但是，大多数农村人口仍无法获得适当的护理。这项研究的目的是通过将任务转移到喀麦隆八个农村卫生区的非内科临床医生（NPC）设施中，检查对高血压和2型糖尿病进行综合护理的有效性。方法在该地区的75个NPC设施中，有69个（占87％）接受了基本设备和高血压和糖尿病护理培训。两年后评估以下方面的有效性：设备状态，受过训练的NPC知识，新发现的患者人数，被护理患者的保留率，患者的治疗成本以及治疗患者的血压（BP）和空腹血糖（FPG）的变化。结果计划实施两年后，有54处设施（78％）可供重新评估，所有设施都具有功能性血压计和听诊器（基线时为65％）; 96％的降压药物库存（基线时为27％）; 70％的人拥有功能正常的血糖仪，而72％的人拥有口服抗糖尿病药（基线时分别为15％和12％）。 NPC在知识测验的多项选择题上的表现得到了显着提高。在两年的时间里，受过训练的NPC对796名高血压和/或糖尿病患者进行了治疗。接受治疗的患者一年的保留率为18.1％。高血压和糖尿病患者的药物治疗费用中位数分别为每月1.4欧元和0.7欧元。在≥2次记录的访视的高血压患者中（n = 493），收缩压下降了22.8 mmHg（95％CI：-20.6至-24.9; p结论）高血压和糖尿病已纳入喀麦隆农村NPC设施的初级卫生保健中就设备和培训而言可行，就治疗费用而言可行，并显示出有前途的BP和FPG趋势，但是，每位NPC的病例检出率低，参与治疗的患者流失率很高，限制了该计划的有效性。

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