Study protocol on Enhanced Primary Healthcare (EnPHC) interventions: a quasi-experimental controlled study on diabetes and hypertension management in primary healthcare clinics

Abstract

Aim: 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. Background: 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. Methods: 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.

Medication Regimen Complexity and Medication Burden Among Patients With Type 2 Diabetes Mellitus: A Retrospective Analysis

“…The clinics were selected by the study team based on their setup and size that reflects care services provided across public health clinics, along with budget and capacity to implement the EnPHC package. Details about the EnPHC project have been described and published elsewhere ( Sivasampu et al, 2020 ). In summary, patients aged 30 years and older with a recorded diagnosis of T2DM or hypertension were sampled from the participating clinics.…”

Optimal cut-off points for adherence measure among patients with type 2 diabetes in primary care clinics: a retrospective analysis

“…The extracted data included demographics (age, gender, ethnicity), risk factors (comorbidities, duration of disease), and laboratory investigation (HbA1c). 13…”

“…The extracted data included demographics (age, gender, ethnicity), risk factors (comorbidities, duration of disease), and laboratory investigation (HbA1c). 13 2. Medication data were obtained from the Pharmacy Information System (PhIS), an electronic medication management system implemented in the public primary care clinics.…”

The Effectiveness of Enhanced Primary Healthcare (EnPHC) Interventions on Type 2 Diabetes Management in Malaysia: Difference-in-differences (DID) Analysis

“…The EnPHC interventions implemented in the 20 intervention clinics beginning in July 2017 encompassed: i) an Integrated Care Pathway (ICP); ii) a patient visit checklist; iii) Integrated Specialized Services (ISS) by allied health professionals; iv) NCD screening and cardiovascular risk strati cation; v) an NCD care form; vi) the Family Health Teams (FHT) concept; vii) involvment of a care coordinator; viii) pharmacist-led Cardiovascular Care Bundle Medication Therapy Adherence Clinic (CCBMTAC); ix) clinical and prescribing audits; and x) structured communication across primary and secondary care levels with a fast track referral system. Further details on the study design and EnPHC interventions have been described elsewhere [8].…”

“…Increasing engagement at all levels of the cascade may allow early detection and minimise morbidity and mortality from diabetes. A previous cascade of care analysis revealed that as many as 50% of individuals with type 2 diabetes in Malaysia were undiagnosed and even after receiving a diagnosis, only 22% had good glycemic control [8].…”