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dc.contributor.authorAnsbro, EM
dc.contributor.authorRoberts, B
dc.contributor.authorJobanputra, K
dc.contributor.authorBiringanine, M
dc.contributor.authorCaleo, G
dc.contributor.authorPrieto-Merino, D
dc.contributor.authorSadique, Z
dc.contributor.authorPerel, P
dc.date.accessioned2020-01-03T17:56:41Z
dc.date.available2020-01-03T17:56:41Z
dc.date.issued2019-11-24
dc.date.submitted2019-12
dc.identifier.issn2044-6055
dc.identifier.issn2044-6055
dc.identifier.doi10.1136/bmjopen-2019-030176
dc.identifier.urihttp://hdl.handle.net/10144/619552
dc.description.abstractObjective We aimed to evaluate an Integrated Diabetic Clinic within a Hospital Outpatient Department (IDC-OPD) in a complex humanitarian setting in North Kivu, Democratic Republic of Congo. Specific objectives were to: (1) analyse diabetes intermediate clinical and programmatic outcomes (blood pressure (BP)/glycaemic control, visit volume and frequency); (2) explore the association of key insecurity and related programmatic events with these outcomes; and (3) describe incremental IDC-OPD programme costs. Design Retrospective cohort analysis of routine programmatic data collected from January 2014 to February 2017; analysis of programme costs for 2014/2015. Setting Outpatient diabetes programme in Mweso hospital, supported by Médecins sans Frontières, in North Kivu, Demographic Republic of Congo. Participants Diabetes patients attending IDC-OPD. Outcome measures Intermediate clinical and programmatic outcome trends (BP/ glycaemic control; visit volume/frequency); incremental programme costs. Results Of 243 diabetes patients, 44.6% were women, median age was 45 (IQR 32–56); 51.4% were classified type 2. On introduction of IDC-OPD, glucose control improved and patient volume and visit interval increased. During insecurity, control rates were initially maintained by a nurse-provided, scaled-back service, while patient volume and visit interval decreased. Following service suspension due to drug stock-outs, patients were less likely to achieve control, improving on service resumption. Total costs decreased 16% from 2014 (€36 573) to 2015 (€30 861). Annual cost per patient dropped from €475 in 2014 to €214 in 2015 due to reduced supply costs and increased patient numbers. Conclusions In a chronic conflict setting, we documented that control of diabetes intermediate outcomes was achievable during stable periods. During insecure periods, a simplified, nurse-led model maintained control rates until drug stock-outs occurred. Incremental per patient annual costs were lower than chronic HIV care costs in low-income settings. Future operational research should define a simplified diabetes care package including emergency preparedness.en_US
dc.language.isoenen_US
dc.publisherBMJen_US
dc.rightsWith thanks to BMJ Global Accessen_US
dc.subjectGeneral Medicine
dc.titleManagement of diabetes and associated costs in a complex humanitarian setting in the Democratic Republic of Congo: a retrospective cohort studyen_US
dc.typejournal-article
dc.identifier.journalBMJ Glob Healthen_US
dc.source.volume9
dc.source.issue11
dc.source.beginpagee030176
refterms.dateFOA2020-01-03T17:56:42Z


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