Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial.
In many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries...
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ftdoajarticles:oai:doaj.org/article:72a55ff8779945f38edb945909dd1271 2023-05-15T17:54:28+02:00 Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial. Lara R Fairall Naomi Folb Venessa Timmerman Carl Lombard Krisela Steyn Max O Bachmann Eric D Bateman Crick Lund Ruth Cornick Gill Faris Thomas Gaziano Daniella Georgeu-Pepper Merrick Zwarenstein Naomi S Levitt 2016-11-01T00:00:00Z https://doi.org/10.1371/journal.pmed.1002178 https://doaj.org/article/72a55ff8779945f38edb945909dd1271 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC5119726?pdf=render https://doaj.org/toc/1549-1277 https://doaj.org/toc/1549-1676 1549-1277 1549-1676 doi:10.1371/journal.pmed.1002178 https://doaj.org/article/72a55ff8779945f38edb945909dd1271 PLoS Medicine, Vol 13, Iss 11, p e1002178 (2016) Medicine R article 2016 ftdoajarticles https://doi.org/10.1371/journal.pmed.1002178 2022-12-31T00:30:17Z In many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries is limited. Primary Care 101 (PC101) is a programme designed to support and expand nurses' role in NCD care, comprising educational outreach to nurses and a clinical management tool with enhanced prescribing provisions. We evaluated the effect of the programme on primary care nurses' capacity to manage NCDs.In a cluster randomised controlled trial design, 38 public sector primary care clinics in the Western Cape Province, South Africa, were randomised. Nurses in the intervention clinics were trained to use the PC101 management tool during educational outreach sessions delivered by health department trainers and were authorised to prescribe an expanded range of drugs for several NCDs. Control clinics continued use of the Practical Approach to Lung Health and HIV/AIDS in South Africa (PALSA PLUS) management tool and usual training. Patients attending these clinics with one or more of hypertension (3,227), diabetes (1,842), chronic respiratory disease (1,157) or who screened positive for depression (2,466), totalling 4,393 patients, were enrolled between 28 March 2011 and 10 November 2011. Primary outcomes were treatment intensification in the hypertension, diabetes, and chronic respiratory disease cohorts, defined as the proportion of patients in whom treatment was escalated during follow-up over 14 mo, and case detection in the depression cohort. Primary outcome data were analysed for 2,110 (97%) intervention and 2,170 (97%) control group patients. Treatment intensification rates in intervention clinics were not superior to those in the control clinics (hypertension: 44% in the intervention group versus 40% in the control group, risk ratio [RR] 1.08 [95% CI 0.94 to 1.24; p = 0.252]; diabetes: 57% versus 50%, RR 1.10 ... Article in Journal/Newspaper palsa Directory of Open Access Journals: DOAJ Articles PLOS Medicine 13 11 e1002178 |
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Medicine R |
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Medicine R Lara R Fairall Naomi Folb Venessa Timmerman Carl Lombard Krisela Steyn Max O Bachmann Eric D Bateman Crick Lund Ruth Cornick Gill Faris Thomas Gaziano Daniella Georgeu-Pepper Merrick Zwarenstein Naomi S Levitt Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial. |
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Medicine R |
description |
In many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries is limited. Primary Care 101 (PC101) is a programme designed to support and expand nurses' role in NCD care, comprising educational outreach to nurses and a clinical management tool with enhanced prescribing provisions. We evaluated the effect of the programme on primary care nurses' capacity to manage NCDs.In a cluster randomised controlled trial design, 38 public sector primary care clinics in the Western Cape Province, South Africa, were randomised. Nurses in the intervention clinics were trained to use the PC101 management tool during educational outreach sessions delivered by health department trainers and were authorised to prescribe an expanded range of drugs for several NCDs. Control clinics continued use of the Practical Approach to Lung Health and HIV/AIDS in South Africa (PALSA PLUS) management tool and usual training. Patients attending these clinics with one or more of hypertension (3,227), diabetes (1,842), chronic respiratory disease (1,157) or who screened positive for depression (2,466), totalling 4,393 patients, were enrolled between 28 March 2011 and 10 November 2011. Primary outcomes were treatment intensification in the hypertension, diabetes, and chronic respiratory disease cohorts, defined as the proportion of patients in whom treatment was escalated during follow-up over 14 mo, and case detection in the depression cohort. Primary outcome data were analysed for 2,110 (97%) intervention and 2,170 (97%) control group patients. Treatment intensification rates in intervention clinics were not superior to those in the control clinics (hypertension: 44% in the intervention group versus 40% in the control group, risk ratio [RR] 1.08 [95% CI 0.94 to 1.24; p = 0.252]; diabetes: 57% versus 50%, RR 1.10 ... |
format |
Article in Journal/Newspaper |
author |
Lara R Fairall Naomi Folb Venessa Timmerman Carl Lombard Krisela Steyn Max O Bachmann Eric D Bateman Crick Lund Ruth Cornick Gill Faris Thomas Gaziano Daniella Georgeu-Pepper Merrick Zwarenstein Naomi S Levitt |
author_facet |
Lara R Fairall Naomi Folb Venessa Timmerman Carl Lombard Krisela Steyn Max O Bachmann Eric D Bateman Crick Lund Ruth Cornick Gill Faris Thomas Gaziano Daniella Georgeu-Pepper Merrick Zwarenstein Naomi S Levitt |
author_sort |
Lara R Fairall |
title |
Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial. |
title_short |
Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial. |
title_full |
Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial. |
title_fullStr |
Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial. |
title_full_unstemmed |
Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial. |
title_sort |
educational outreach with an integrated clinical tool for nurse-led non-communicable chronic disease management in primary care in south africa: a pragmatic cluster randomised controlled trial. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2016 |
url |
https://doi.org/10.1371/journal.pmed.1002178 https://doaj.org/article/72a55ff8779945f38edb945909dd1271 |
genre |
palsa |
genre_facet |
palsa |
op_source |
PLoS Medicine, Vol 13, Iss 11, p e1002178 (2016) |
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http://europepmc.org/articles/PMC5119726?pdf=render https://doaj.org/toc/1549-1277 https://doaj.org/toc/1549-1676 1549-1277 1549-1676 doi:10.1371/journal.pmed.1002178 https://doaj.org/article/72a55ff8779945f38edb945909dd1271 |
op_doi |
https://doi.org/10.1371/journal.pmed.1002178 |
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PLOS Medicine |
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13 |
container_issue |
11 |
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e1002178 |
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