Implementing Package of Essential Non-communicable Disease Interventions in the Republic of Moldova—a feasibility study

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Evaluation and pilot implementation of essential interventions for the management of hypertension and prevention of cardiovascular diseases in primary health care in the Republic of Tajikistan

“…In contrast to our study, the prescriptions of statins for CVD patients did not change in intervention clinics and even deteriorated in control clinics. [ 18 ].…”

Implementing a package of noncommunicable disease interventions in the Republic of Moldova: two-year follow-up data

“…(Collins et al, 2019) The one-year follow-up data are published in the European Journal of Public Health, along with additional methodological information. (Laatikainen et al, 2020) In short, we conducted a feasibility study of a cluster randomized controlled trial of primary health care facilities (n = 20) which were randomly allocated to intervention (n = 10) or control (n = 10) ( Figure 1). The intervention is described in detail elsewhere, but in brief consisted of adapted clinical protocols, training of primary care clinicians, technical and follow-up support.…”

“…(Collins et al, 2019;Laatikainen et al, 2020) In short, after one-year of follow-up, we concluded that WHO PEN protocols 1 and 2 were implementable in primary health care and that routine paper-based clinical data could be used to assess the effectiveness of these interventions. (Laatikainen et al, 2020) Secondary to this, the study also evaluated the baseline performance of primary health care services and the change after one year. These analyses demonstrated that modest improvements in risk factor identification and management could be achieved in a relatively short period of time.…”

“…Thus, the a priori outcomes were assessed again at second year using the previously described methodology. (Collins et al, 2019;Laatikainen et al, 2020) Herein, we report the second-year follow-up data from the aforementioned feasibility study.…”

“…These analyses demonstrated that modest improvements in risk factor identification and management could be achieved in a relatively short period of time. (Laatikainen et al, 2020) While our original protocol for the evaluation of the pilot implementation detailed assessment of outcomes at one-year follow-up, in preparation for potential national scale up of the interventions, there was interest by key stakeholders in the longerterm impact and sustainability of the interventions (some of which ceased after 12 months). Not least because the prevention and management of NCDs require long term control of risk factors.…”