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

• Published in: PLOS Medicine
• Main Authors: Fairall, Lara R., Folb, Naomi, Timmerman, Venessa, Lombard, Carl, Steyn, Krisela, Bachmann, Max O., Bateman, Eric D., Lund, Crick, Cornick, Ruth, Faris, Gill, Gaziano, Thomas, Georgeu-Pepper, Daniella, Zwarenstein, Merrick, Levitt, Naomi S.
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2016
• Subjects: palsa
• Online Access: https://kclpure.kcl.ac.uk/portal/en/publications/bb4f5315-0aea-4287-977b-5e8c361d9cae; https://doi.org/10.1371/journal.pmed.1002178; https://kclpure.kcl.ac.uk/ws/files/148944013/pmed.1002178.pdf; http://www.scopus.com/inward/record.url?scp=84999749822&partnerID=8YFLogxK

Background: 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. Methods and Findings: 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]; ...