Department of Internal Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.
Department of Public Health Nutrition and Dietetics, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
BMJ Open. 2021 Jan 4;11(1):e040564. doi: 10.1136/bmjopen-2020-040564.
Integrating early detection and management of non-communicable diseases in primary healthcare has an unprecedented role in making healthcare more accessible particularly in low- and middle-income countries such as Ethiopia. This study aims to design, implement and evaluate an evidence-based intervention guided by the HEARTS technical package and implementation guide to address barriers and facilitators of integrating early detection and management of hypertension, diabetes mellitus and cardiovascular diseases in primary healthcare settings of Addis Ababa.
We will employ a type-3 hybrid implementation-effectiveness study from November 2020 to May 2022. This study will target patients ≥40 years of age. Ten health centres will be randomly selected from each subcity of Addis Ababa. The study will have four phases: (1) Baseline situational analysis (PEN facility-capacity assessment, 150 observations of patient healthcare provider interactions and 697 patient medical record reviews), (2) Consolidated Framework for Implementation Research (CFIR) inspired qualitative assessment of barriers and facilitators (20 in-depth interviews of key stakeholders), (3) Design of intervention protocol. The intervention will have capacity enhancement components including training of non-communicabledisease (NCDservice providers, provision of essential equipment/supporting materials and monthly monitoring and feedback and (4) Implementation monitoring and evaluation phase using the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework. Outcomes on early detection and management of NCDs will be assessed to examine the effectiveness of the study.
Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board and Addis Ababa Health Bureau. We plan to present the findings from this research in conferences and publish them in peer-reviewed journals.
在初级保健中整合非传染性疾病的早期发现和管理，在使医疗保健更具可及性方面具有前所未有的作用，特别是在埃塞俄比亚等中低收入国家。本研究旨在设计、实施和评估一项基于 HEARTS 技术包和实施指南的循证干预措施，以解决在亚的斯亚贝巴初级保健环境中整合高血压、糖尿病和心血管疾病的早期发现和管理的障碍和促进因素。
我们将采用 2020 年 11 月至 2022 年 5 月期间的 3 型混合实施效果研究。本研究将以年龄≥40 岁的患者为目标。将从亚的斯亚贝巴的每个分区随机选择 10 个卫生中心。研究将分为四个阶段：（1）基线情况分析（PEN 设施能力评估、150 次患者与医疗服务提供者互动观察和 697 次患者病历审查）；（2）基于综合实施研究框架（CFIR）的障碍和促进因素定性评估（20 名关键利益攸关方的深入访谈）；（3）干预方案设计。干预措施将包括能力增强部分，包括对非传染性疾病（NCD）服务提供者进行培训、提供基本设备/支持材料以及每月监测和反馈；（4）使用 RE-AIM（覆盖范围、效果、采用、实施和维护）框架进行实施监测和评估阶段。将评估非传染性疾病早期发现和管理的结果，以检验研究的效果。
该研究已获得亚的斯亚贝巴大学、健康科学学院伦理审查委员会和亚的斯亚贝巴卫生局的伦理批准。我们计划在会议上介绍这项研究的结果，并在同行评议的期刊上发表。
