PDF(Pubmed)
Abstract：
BACKGROUND: Eswatini faces persistent challenges in providing care for diabetes and hypertension, exacerbated by a shortage of healthcare workers. The implementation of WHO-PEN interventions aimed to address these issues, yet their effects on healthcare worker time requirements and associated costs remain unclear.
METHODS: This study employed a time-and-motion analysis and a bottom-up cost assessment to quantify the human and financial resources required for scaling up WHO-PEN interventions nationally in Eswatini for all estimated diabetic and hypertensive patients.
RESULTS: Findings reveal that healthcare workers in intervention-arm clinics reported longer workday durations compared to those in control-arm clinics, yet spent less time per patient while seeing more patients. The implementation of WHO-PEN interventions increased the workload on healthcare workers but also led to a notable increase in patient care utilization. Furthermore, a morning peak in patient visits was identified, suggesting potential opportunities for optimizing patient flow. Notably, scaling up care provision nationally with WHO-PEN interventions proved to be more cost saving than expanding standard-of-care treatment.
CONCLUSIONS: WHO-PEN interventions hold promise in improving access to diabetes and hypertension care in Eswatini while offering an efficient solution. However, addressing challenges in healthcare workforce creation and retention is crucial for sustained effectiveness. Policy makers must consider all aspects of the WHO-PEN intervention for informed decision-making. Trial registration US Clinical Trials Registry. NCT04183413. Trial registration date: December 3, 2019. https://ichgcp.net/clinical-trials-registry/NCT04183413.
METHODS: This study employed a time-and-motion analysis and a bottom-up cost assessment to quantify the human and financial resources required for scaling up WHO-PEN interventions nationally in Eswatini for all estimated diabetic and hypertensive patients.
RESULTS: Findings reveal that healthcare workers in intervention-arm clinics reported longer workday durations compared to those in control-arm clinics, yet spent less time per patient while seeing more patients. The implementation of WHO-PEN interventions increased the workload on healthcare workers but also led to a notable increase in patient care utilization. Furthermore, a morning peak in patient visits was identified, suggesting potential opportunities for optimizing patient flow. Notably, scaling up care provision nationally with WHO-PEN interventions proved to be more cost saving than expanding standard-of-care treatment.
CONCLUSIONS: WHO-PEN interventions hold promise in improving access to diabetes and hypertension care in Eswatini while offering an efficient solution. However, addressing challenges in healthcare workforce creation and retention is crucial for sustained effectiveness. Policy makers must consider all aspects of the WHO-PEN intervention for informed decision-making. Trial registration US Clinical Trials Registry. NCT04183413. Trial registration date: December 3, 2019. https://ichgcp.net/clinical-trials-registry/NCT04183413.
摘要：
背景：Eswatini在提供糖尿病和高血压治疗方面面临着持续的挑战，医护人员短缺加剧了。实施旨在解决这些问题的WHO-PEN干预措施，然而,它们对医护人员时间要求和相关成本的影响仍不清楚.
方法：这项研究采用了时间和运动分析和自下而上的成本评估，以量化在埃斯瓦蒂尼全国范围内扩大WHO-PEN干预措施所需的人力和财政资源。
结果：研究结果表明，与控制臂诊所相比，干预臂诊所的医护人员报告的工作日持续时间更长，然而每个患者花费的时间更少，而看更多的患者。世卫组织-PEN干预措施的实施增加了医护人员的工作量，但也导致患者护理利用率显着增加。此外，确定了患者就诊的早晨高峰，建议优化患者流量的潜在机会。值得注意的是,通过WHO-PEN干预措施在全国范围内扩大护理提供被证明比扩大护理标准治疗更节约成本。
结论：WHO-PEN干预措施有望改善Eswatini的糖尿病和高血压治疗，同时提供有效的解决方案。然而,解决医疗保健劳动力创建和保留方面的挑战对于持续有效至关重要。政策制定者必须考虑世卫组织-PEN干预措施的所有方面，以便做出知情决策。试验注册美国临床试验注册中心。NCT04183413。试用注册日期：2019年12月3日。https://ichgcp.net/clinical-trials-registry/NCT04183413。
方法：这项研究采用了时间和运动分析和自下而上的成本评估，以量化在埃斯瓦蒂尼全国范围内扩大WHO-PEN干预措施所需的人力和财政资源。
结果：研究结果表明，与控制臂诊所相比，干预臂诊所的医护人员报告的工作日持续时间更长，然而每个患者花费的时间更少，而看更多的患者。世卫组织-PEN干预措施的实施增加了医护人员的工作量，但也导致患者护理利用率显着增加。此外，确定了患者就诊的早晨高峰，建议优化患者流量的潜在机会。值得注意的是,通过WHO-PEN干预措施在全国范围内扩大护理提供被证明比扩大护理标准治疗更节约成本。
结论：WHO-PEN干预措施有望改善Eswatini的糖尿病和高血压治疗，同时提供有效的解决方案。然而,解决医疗保健劳动力创建和保留方面的挑战对于持续有效至关重要。政策制定者必须考虑世卫组织-PEN干预措施的所有方面，以便做出知情决策。试验注册美国临床试验注册中心。NCT04183413。试用注册日期：2019年12月3日。https://ichgcp.net/clinical-trials-registry/NCT04183413。
