Te Vannarath, Wouters Edwin, Buffel Veerle, Van Damme Wim, van Olmen Josefien, Ir Por
Health Policy and Systems Research Unit, National Institute of Public Health, Phnom Penh, Cambodia.
Health Policy Unit, Department of Public Health, Institute of Tropical Medicine (Antwerp), Antwerp, Belgium.
JMIR Res Protoc. 2022 Sep 2;11(9):e36747. doi: 10.2196/36747.
Cardiovascular diseases (CVDs) were accountable for 24% of the total deaths in Cambodia, one of the low- and middle-income countries, where primary health care (PHC) settings generally do not perform well in the early detection, diagnosis, and monitoring of leading risk factors for CVDs, that is, type 2 diabetes (T2D) and hypertension (HT). Integrated care for T2D and HT in the Cambodian PHC system remains limited, with more than two-thirds of the population never having had their blood glucose measured and more than half of the population with T2D having not received treatment, with only few of them achieving recommended treatment targets. With regard to care for T2D and HT in the public health care system, 3 care models are being scaled up, including (1) a hospital-based model, (2) a health center-based model, and (3) a community-based model. These 3 care models are implemented in isolation with relatively little interaction between each other. The question arises as to what extent the 3 care models have performed in providing care to patients with T2D or HT or both in Cambodia.
This protocol aims to show how to use primary data from a population-based survey to generate data for the cascades of care to assess the continuum of care for T2D and HT across different care models.
We adapt the HIV test-treat-retain cascade of care to assess the continuum of care for patients living with T2D and HT. The cascade-of-care approach outlines the sequential steps in long-term care: testing, diagnosis, linkage with care, retention in care, adherence to treatment, and reaching treatment targets. Five operational districts (ODs) in different provinces will be purposefully selected out of 103 ODs across the country. The population-based survey will follow a multistage stratified random cluster sampling, with expected recruitment of 5280 eligible individuals aged 40 and over as the total sample size. Data collection process will follow the STEPS (STEPwise approach to NCD risk factor surveillance) survey approach, with modification of the sequence of the steps to adapt the data collection to the study context. Data collection involves 3 main steps: (1) structured interviews with questionnaires, (2) anthropometric measurements, and (3) biochemical measurements.
As of December 2021, the recruitment process was completed, with 5072 eligible individuals participating in the data collection; however, data analysis is pending. Results are expected to be fully available in mid-2022.
The cascade of care will allow us to identify leakages in the system as well as the unmet need for care. Identifying gaps in the health system is vital to improve efficiency and effectiveness of its performance. This study protocol and its expected results will help implementers and policy makers to assess scale-up and adapt strategies for T2D and HT care in Cambodia.
International Standard Randomised Controlled Trials Number (ISRCTN) registry ISRCTN41932064; https://www.isrctn.com/ISRCTN41932064.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36747.
在柬埔寨这个低收入和中等收入国家之一，心血管疾病（CVDs）占总死亡人数的24%。在柬埔寨，初级卫生保健（PHC）机构在心血管疾病主要危险因素即2型糖尿病（T2D）和高血压（HT）的早期检测、诊断及监测方面普遍表现不佳。柬埔寨初级卫生保健系统中对T2D和HT的综合护理仍然有限，超过三分之二的人口从未测量过血糖，超过一半的T2D患者未接受治疗，只有少数人达到推荐的治疗目标。在公共卫生保健系统中，针对T2D和HT的护理有3种模式正在扩大推广，包括：（1）基于医院的模式；（2）基于健康中心的模式；（3）基于社区的模式。这3种护理模式各自独立实施，相互之间的互动相对较少。问题在于这3种护理模式在柬埔寨为T2D或HT患者或两者兼具的患者提供护理方面表现如何。
本方案旨在展示如何利用基于人群调查的原始数据生成护理级联数据，以评估不同护理模式下T2D和HT的连续护理情况。
我们采用HIV检测 - 治疗 - 留存护理级联来评估T2D和HT患者的连续护理情况。护理级联方法概述了长期护理中的连续步骤：检测、诊断、与护理建立联系、留存于护理、坚持治疗以及达到治疗目标。将从全国103个业务区中有目的地选取不同省份的5个业务区（ODs）。基于人群的调查将采用多阶段分层随机整群抽样，预计招募5280名40岁及以上的符合条件个体作为总样本量。数据收集过程将遵循STEP（非传染性疾病危险因素监测的逐步方法）调查方法，并对步骤顺序进行调整，以使数据收集适应研究背景。数据收集涉及3个主要步骤：（1）使用问卷进行结构化访谈；（2）人体测量；（3）生化测量。
截至2021年12月，招募过程完成，有5072名符合条件的个体参与了数据收集；然而，数据分析尚待进行。预计结果将于2022年年中全面可得。
护理级联将使我们能够识别系统中的漏洞以及未满足的护理需求。识别卫生系统中的差距对于提高其绩效的效率和效果至关重要。本研究方案及其预期结果将有助于实施者和政策制定者评估柬埔寨T2D和HT护理的扩大推广及调整策略。
国际标准随机对照试验编号（ISRCTN）注册库ISRCTN41932064；https://www.isrctn.com/ISRCTN41932064。
国际注册报告识别号（IRRID）：DERR1 - 10.2196/36747。
