Abstract
This paper describes the study protocol, which aims to evaluate the effectiveness of a multifaceted intervention package called 'Enhanced Primary Healthcare' (EnPHC) on the process of care and intermediate clinical outcomes among patients with Type 2 diabetes mellitus (T2DM) and hypertension. Other outcome measures include patients' experience and healthcare providers' job satisfaction. In 2014, almost two-thirds of Malaysia's adult population aged 18 years or older had T2DM, hypertension or hypercholesterolaemia. An analysis of health system performance from 2016 to 2018 revealed that the control and management of diabetes and hypertension in Malaysia was suboptimal with almost half of the patients not diagnosed and just one-quarter of patients with diabetes appropriately treated. EnPHC framework aims to improve diagnosis and effective management of T2DM, hypertension or hypercholesterolaemia and their risk factors by increasing prevention, optimising management and improving surveillance of diagnosed patients. This is a quasi-experimental controlled study which involves 20 intervention and 20 control clinics in two different states in Malaysia, namely Johor and Selangor. The clinics in the two states were matched and randomly allocated to 'intervention' and 'control' arms. The EnPHC framework targets different levels from community to primary healthcare clinics and integrated referral networks.Data are collected via a retrospective chart review (RCR), patient exit survey, healthcare provider survey and an intervention checklist. The data collected are entered into tablet computers which have installed in them an offline survey application. Interrupted time series and difference-in-differences (DiD) analyses will be conducted to report outcomes.
Highlights
The burden of non-communicable diseases (NCDs) such as cardiovascular diseases (CVDs), chronic obstructive lung diseases, cancer and diabetes affects health and the socio-economic development of countries (Mendis, 2014; Bommer et al, 2018; Niessen et al, 2018)
The aim of this paper is to describe the sequential steps taken to evaluate the Enhanced Primary Healthcare’ (EnPHC) interventions at primary healthcare clinics (EnPHC-EVA: Facility) and the methods used
The EnPHC intervention and evaluation studies aim to apply a set of multifaceted, person-centred interventions that are believed to be effective on the overall management and prevention of NCDs
Summary
The burden of non-communicable diseases (NCDs) such as cardiovascular diseases (CVDs), chronic obstructive lung diseases, cancer and diabetes affects health and the socio-economic development of countries (Mendis, 2014; Bommer et al, 2018; Niessen et al, 2018). High systolic blood pressure, fasting plasma glucose and body mass index are the leading risk factors of disability-adjusted life years globally (GBD 2017 Risk Factor Collaborators, 2018) These metabolic risk factors are known to increase CVD which is the main contributor to NCD-related premature death (World Health Organization, 2018). A comprehensive situational analysis of the Malaysian health system undertaken in 2016– 2018 revealed that the NCD burden is very high and is rapidly increasing with almost two-thirds of Malaysian adult population having at least one of the three NCDs – Type 2 diabetes mellitus (T2DM), hypertension or hypercholesterolaemia (Institute for Public Health, 2015; Ministry of Health Malaysia and Harvard University TH Chan School of Public Health, 2016) This analysis, which used a ‘care cascade’ framework, revealed major gaps in awareness of risk, timely
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