Improved retention rates with low‐cost interventions in hypertension and diabetes management in a rural African environment of nurse‐led care: a cluster‐randomised trial
Objective To compare the effects of low‐level facility‐based interventions on patient retention rates for cardiovascular (CV) disease in an environment of task shifting and nurse‐led care in rural health districts in Central Cameroon.
Methods This study is an open‐label, three‐arm, cluster‐randomised trial in nurse‐led facilities. All three groups implemented a treatment contract. The control group (group 1) had no additional intervention, group 2 received the incentive of 1 month of free treatment every forth month of regularly respected visits, and group 3 received reminder letters in case of a missed follow‐up visit. The primary outcome was patient retention at 1 year. Secondary outcomes were adherence to follow‐up visit schemes and changes in blood pressure (BP) and blood glucose levels. Patients’ monthly spending for drugs and transport was calculated retrospectively.
Results A total of 33 centres and 221 patients were included. After 1 year, 109 patients (49.3%) remained in the programme. Retention rates in groups 2 and 3 were 60% and 65%, respectively, against 29% in the control group. The differences between the intervention groups and the control group were significant (P < 0.001), but differences between the two intervention groups were not (P = 0.719). There were no significant differences in BP or fasting plasma glucose trends between retained patients in the study groups. Average monthly cost to patients for antihypertensive medication was € 1.1 ± 0.9 and for diabetics €1.2 ± 1.1. Transport costs to the centres were on average €1.1 ± 1.0 for hypertensive patients and €1.1 ± 1.6 for patients with diabetes.
Conclusions Low‐cost interventions suited to an environment of task shifting and nurse‐led care and needing minimal additional resources can significantly improve retention rates in CV disease management in rural Africa. The combination of a treatment contract and reminder letters in case of missed appointments was an effective measure to retain patients in care.
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