Institute of Public Health and Clinical Nutrition, Faculty of Medicine, University of Eastern Finland, Kuopio, Finland.
Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.
Eur J Public Health. 2020 Dec 11;30(6):1146-1151. doi: 10.1093/eurpub/ckaa037.
The aim of this study is to determine the feasibility of implementing and evaluating the World Health Organization Package of Essential Non-communicable Disease Interventions (WHO PEN) approach in primary healthcare in the Republic of Moldova.
According to our published a priori methods, 20 primary care clinics were randomized to 10 intervention and 10 control clinics. The intervention consisted of implementation of adapted WHO PEN guidelines and structured training for health workers; the control clinics continued with usual care. Data were gathered from paper-based patient records in July 2017 and August 2018 resulting in a total of 1174 and 995 patients in intervention and control clinics at baseline and 1329 and 1256 at follow-up. Pre-defined indicators describing assessment of risk factors and total cardiovascular risk, prescribing medications and treatment outcomes were calculated. Differences between baseline and follow-up as well as between intervention and control clinics were calculated using logistic and linear regression models and by assessing interaction effects.
Improvements were seen in recording smoking status, activity to measure HbA1c among diabetes patients and achieving control in hypertension treatment. Improvement was also seen in identification of patients with hypertension or diabetes. Less improvement or even deterioration was seen in assessing total risk or prescribing statins for high-risk patients.
It is feasible to evaluate the quality and management of patients with non-communicable diseases in low-resource settings from routine data. Modest improvements in risk factor identification and management can be achieved in a relatively short period of time.
本研究旨在确定在摩尔多瓦共和国的基层医疗保健中实施和评估世界卫生组织基本非传染性疾病干预包（WHO PEN）方法的可行性。
根据我们已发表的预设方法，将 20 家基层医疗诊所随机分为 10 家干预诊所和 10 家对照诊所。干预措施包括实施经改编的 WHO PEN 指南和对卫生工作者进行结构化培训；对照诊所继续采用常规护理。数据于 2017 年 7 月和 2018 年 8 月从纸质病历中收集，干预组和对照组的基线患者分别为 1174 名和 995 名，随访患者分别为 1329 名和 1256 名。计算了描述危险因素和心血管总风险评估、药物处方和治疗结果的预定义指标。使用逻辑回归和线性回归模型以及评估交互效应，计算了基线和随访之间以及干预组和对照组之间的差异。
在记录吸烟状况、测量糖尿病患者的 HbA1c 活动以及控制高血压治疗方面，记录得到了改善。在识别高血压或糖尿病患者方面也有所改善。在评估总风险或为高危患者开具他汀类药物方面，改善较小或甚至恶化。
从常规数据评估资源匮乏环境中非传染性疾病患者的质量和管理是可行的。在相对较短的时间内，可以实现对危险因素的识别和管理的适度改善。
