以医院为基础的镰状细胞综合护理方案的有效性,以提高印度西部部落地区已证实的干预措施的覆盖率

Kapilkumar Dave, Gayatri Desai, Reena Gupta, Dhiren Modi, Shrey Desai
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引用次数: 0

摘要

目的:本研究的目的是评估综合医院为基础的镰状细胞病(SCD)模型的有效性,该模型涉及改进印度古吉拉特邦部落地区已证实的干预措施。方法:这是一项准实验研究,涉及五个初级卫生中心,每个中心作为干预组和对照组。这项研究于2016年6月至2018年5月在印度古吉拉特邦的三个部落地区进行。干预是一种以医院为基础的SCD患者综合护理模式。我们纳入了研究区域内年龄在5至40岁之间的所有SCD患者。我们通过家庭调查在基线和终点线测量结果。分析是用差中差法进行的。结果:干预组84例,对照组101例。两组的基线特征具有可比性。在终点线,与对照组相比,已证实的干预措施的覆盖率有显著差异,包括肺炎球菌疫苗接种-比值比(OR)为21.3 (95% CI 9.7-46.8, P值0.002),叶酸-比值比为4.1 (CI 2.2-7.8, P <0.001),氯喹-比值比为4.9 (CI 2.4-10.2, P <0.001),以及严重SCD患者的羟基脲-比值比为7.1 (CI 1.8-28.6, P <0.001)。干预组疼痛危重率(平均差值[MD]: - 0.18[- 1.17-0.812])、住院率(MD: - 0.08[- 0.375-0.210])、输血率(MD: - 0.60[- 0.532-0.412])等临床结局指标与对照组比较改善无统计学意义。结论:本研究表明,以医院为基础的SCD综合模型具有很大的潜力,可以提高已证实的SCD干预措施的覆盖率。需要进一步的研究来评估对临床结果的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effectiveness of a hospital-based comprehensive sickle cell care program to improve coverage of proven interventions in tribal areas of Western India
Objective: The objective of this study was to assess the effectiveness of a comprehensive hospital-based sickle cell disease (SCD) model involving improvements of proven interventions in a tribal area of Gujarat, India. Methods: This was a quasi-experimental study involving five primary health centers each in the intervention and control groups. This study was conducted from June 2016 to May 2018 in three tribal areas of Gujarat, India. The intervention was a hospital-based comprehensive care model for SCD patients. We included all SCD patients between the ages of 5 and 40 years in the study area. We measured outcomes at baseline and end line by household survey. The analysis was done using a difference-in-difference method. Results: A total of 84 and 101 patients were recruited in the intervention and control groups, respectively. The baseline characteristics were comparable in both the groups. At end line, there was a significant difference in coverage of proven interventions including pneumococcal vaccination- odds ratio (OR) 21.3 (95% CI 9.7–46.8, P value 0.002), folic acid - OR 4.1 (CI 2.2–7.8, P <0.001), chloroquine –OR 4.9 (CI 2.4–10.2, P <0.001), and hydroxyurea for severe SCD patients - OR7.1 (CI 1.8–28.6, P < 0.001) in the intervention group compared to the control group. The improvement for the clinical outcome indicators including pain crisis rate (mean difference [MD]: −0.18 [−1.17–0.812]), hospitalization rate (MD: −0.08 [−0.375–0.210]), and blood transfusion rate (MD: −0.60 [−0.532–0.412]) in the intervention group in comparison with the control group was nonsignificant. Conclusion: This study shows that the comprehensive hospital-based SCD model has great potential to improve the coverage of proven interventions for SCD. Further investigation is needed to assess the impact on clinical outcomes.
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