دورية أكاديمية
Effectiveness of an integrated diabetes care package at primary healthcare facilities: a cluster randomised trial in Pakistan.
| العنوان: | Effectiveness of an integrated diabetes care package at primary healthcare facilities: a cluster randomised trial in Pakistan. |
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| المؤلفون: | Khan MA; Chief Coordinating Professional, Association for Social Development, Islamabad, Pakistan., Walley JD; Professor of International Public Health, Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, Leeds, UK., Khan N; Project Coordinator, Association for Social Development, Islamabad, Pakistan., Hicks J; Senior Medical Statistician, Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, Leeds, UK., Ahmed M; Senior Professional, Association for Social Development, Islamabad, Pakistan., Khan SE; Assistant Professor, Humanities and Social Sciences Department, Bahria University, Islamabad, Pakistan., Khan MA; Research Coordinator, Association for Social Development, Islamabad, Pakistan., Khan HJ; Director, NCD & Mental Health, Directorate General of Health Services, Lahore, Pakistan., Harries AD; Senior Advisor, Department of Research, International Union Against Tuberculosis and Lung Disease, Winchester, UK. |
| المصدر: | BJGP open [BJGP Open] 2018 Dec 12; Vol. 2 (4), pp. bjgpopen18X101618. Date of Electronic Publication: 2018 Dec 12 (Print Publication: 2018). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Royal College of General Practitioners Country of Publication: England NLM ID: 101713531 Publication Model: eCollection Cited Medium: Internet ISSN: 2398-3795 (Electronic) Linking ISSN: 23983795 NLM ISO Abbreviation: BJGP Open Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: London : Royal College of General Practitioners, [2017]- |
| مستخلص: | Background: There were an estimated 7 million people living with diabetes in Pakistan in 2014, and this is predicted to reach 11.4 million by 2030. Aim: To assess if an integrated care package can achieve better control of diabetes. Design & Setting: The pragmatic cluster randomised controlled trial (cRCT) was conducted from December 2014-June 2016 at 14 primary healthcare facilities in Sargodha district. Opportunistic screening, diagnostic testing, and patient recording processes were introduced in both the control 'testing, treating, and recording' (TTR) arm, and the intervention 'additional case management' (ACM) arm, which also included a clinical care guide and pictorial flipbook for lifestyle education, associated clinician training, and mobile phone follow-up. Method: Clinics were randomised on a 1:1 basis (sealed envelope lottery method) and 250 patients recruited in the ACM arm and 245 in the TTR-only arm (age ≥25 years and HbA1c >7%). The primary outcome was mean change in HbA1c (%) from baseline to 9-month follow-up. Patients and staff were not blinded. Results: The primary outcome was available for n = 238/250 (95.2%) participants in the ACM arm and n = 219/245 (89.4%) participants in the TTR-only arm (all clusters). Cluster level mean outcome was -2.26 pp (95% confidence intervals [CI] = -2.99 to -1.53) for the ACM arm, and -1.44 pp (95% CI = -2.34 to -0.54) for the TTR-only arm. Cluster level mean ACM-TTR difference (covariate-unadjusted) was -0.82 pp (95% CI = -1.86 to 0.21; P = 0.11). Conclusion: The ACM intervention in public healthcare facilities did not show a statistically significant effect on HbA1c reduction compared to the control (TTR-only) arm. Future evaluation should assess changes after a longer follow-up period, and minimal care enhancement in the comparator (control) arm. Competing Interests: The authors declare that no competing interests exist. |
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| تواريخ الأحداث: | Date Created: 20190207 Latest Revision: 20220331 |
| رمز التحديث: | 20240628 |
| مُعرف محوري في PubMed: | PMC6348328 |
| DOI: | 10.3399/bjgpopen18X101618 |
| PMID: | 30723803 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2398-3795 |
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| DOI: | 10.3399/bjgpopen18X101618 |