基于社区的墨西哥农村非传染性疾病治疗方案的实施和临床效果：一项差分分析。
Implementation and clinical effectiveness of a community-based non-communicable disease treatment programme in rural Mexico: a difference-in-differences analysis.
机构信息
Compañeros En Salud/Partners in Health Mexico, Calle Primera Poniente Sur No. 25, Ángel Albino Corzo, Chiapas, Mexico.
Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
出版信息
Health Policy Plan. 2018 Jul 1;33(6):707-714. doi: 10.1093/heapol/czy041.
Non-communicable diseases (NCDs) account for the five largest contributors to burden of disease in Mexico, with diabetes representing the greatest contributor. However, evidence supporting chronic disease programmes in Mexico is limited, especially in rural communities. Compañeros En Salud (CES) partnered with the Secretariat of Health of Chiapas, Mexico to implement a novel community-based NCD treatment programme. We describe the implementation of this programme and conducted a population-based, retrospective analysis, using a difference-in-differences regression approach to estimate the impact of the programme. Specifically, we examined changes in diabetes and hypertension control rates between 2014 and 2016, comparing CES intervention clinics (n = 9) to care-as-usual at non-CES clinics (n = 806), adjusting for differences in facility-level characteristics. In 2014, the percent of diabetes patients with this condition under control was 36.9% at non-CES facilities, compared with 41.3% at CES facilities (P > 0.05). For hypertension patients, these figures were 45.2% at non-CES facilities compared with 56.2% at CES facilities (P = 0.02). From 2014 to 2016, the percent of patients with diabetes under control declined by 9.2% at non-CES facilities, while improving by 11.3% at non-CES facilities where the Compañeros En Salud Programa de Enfermedades Crónicas intervention was implemented (P < 0.001). Among hypertension patients, those with the condition under control increased by 21.5% at non-CES facilities between 2014 and 2016, compared with 16.2% at CES facilities (P > 0.05). Introduction of the CES model of NCD care was associated with significantly greater improvements in diabetes management between 2014 and 2016, compared with care-as-usual. Hypertension control measures were already greater at CES facilities in 2014, a difference that was maintained through 2016. These findings highlight the successful implementation of a framework for providing NCD care in rural Mexico, where a rapidly increasing NCD disease burden exists.
非传染性疾病（NCDs）占墨西哥疾病负担的五个最大贡献者，其中糖尿病的贡献最大。然而，支持墨西哥慢性病项目的证据有限，特别是在农村社区。Compañeros En Salud（CES）与墨西哥恰帕斯州卫生秘书处合作，实施了一项新的基于社区的非传染性疾病治疗方案。我们描述了该方案的实施情况，并进行了一项基于人群的回顾性分析，使用差异中的差异回归方法来估计该方案的影响。具体来说，我们检查了 2014 年至 2016 年期间糖尿病和高血压控制率的变化，将 CES 干预诊所（n=9）与非 CES 诊所的常规护理（n=806）进行比较，调整了设施水平特征的差异。2014 年，非 CES 设施中糖尿病患者的控制率为 36.9%，而 CES 设施中为 41.3%（P>0.05）。对于高血压患者，这些数字分别为非 CES 设施中的 45.2%和 CES 设施中的 56.2%（P=0.02）。从 2014 年到 2016 年，非 CES 设施中糖尿病患者的控制率下降了 9.2%，而在实施 Compañeros En Salud 慢性病项目干预的非 CES 设施中，这一比例上升了 11.3%（P<0.001）。在高血压患者中，2014 年至 2016 年间，非 CES 设施中控制病情的患者增加了 21.5%，而 CES 设施中增加了 16.2%（P>0.05）。引入 CES 模式的非传染性疾病护理与 2014 年至 2016 年间糖尿病管理的显著改善有关，而与常规护理相比。2014 年，CES 设施中高血压控制措施已经更好，这一差异在 2016 年得以维持。这些发现突出了在墨西哥农村地区提供非传染性疾病护理的框架的成功实施，那里的非传染性疾病负担迅速增加。
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