Training Mid-Level Providers to Treat Severe Non-Communicable Diseases in Neno, Malawi through PEN-Plus Strategies
Background: Non-communicable diseases (NCDs) are a leading cause of worldwide morbidity and mortality, yet access to care in lower-income countries is limited. Rural communities, where poverty levels are high, feel the greatest burden. In Malawi, as elsewhere in the African region, it is particularl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Ubiquity Press
2022-08-01
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| Series: | Annals of Global Health |
| Subjects: | |
| Online Access: | https://annalsofglobalhealth.org/articles/3750 |
| _version_ | 1811260391786807296 |
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| author | Todd Ruderman Evelyn Chibwe Chantelle Boudreaux Enoch Ndarama Emily B. Wroe Emilia Connolly Gene Bukhman |
| author_facet | Todd Ruderman Evelyn Chibwe Chantelle Boudreaux Enoch Ndarama Emily B. Wroe Emilia Connolly Gene Bukhman |
| author_sort | Todd Ruderman |
| collection | DOAJ |
| description | Background: Non-communicable diseases (NCDs) are a leading cause of worldwide morbidity and mortality, yet access to care in lower-income countries is limited. Rural communities, where poverty levels are high, feel the greatest burden. In Malawi, as elsewhere in the African region, it is particularly challenging for patients in rural districts to obtain care for locally endemic and severe NCDs such as type 1 diabetes, rheumatic heart disease, and sickle cell disease. The Package of Essential NCD Interventions – Plus (PEN-Plus) is a strategy to decentralize care for these severe conditions by enabling local clinicians at intermediate-care facilities to provide services otherwise available only through specialty clinics at central hospitals. Objectives: The primary objective of this study was to evaluate the impact of training mid-level providers to treat severe and chronic NCDs in newly established PEN-Plus clinics in Neno, Malawi. Methods: Our team developed a logic model to describe the anticipated impacts of the intervention on provider knowledge, patient recruitment, and care provision. We applied a retrospective review of routinely collected clinical and administrative data to assess changes along these hypothesized pathways. Findings: Didactic trainings improved provider test scores immediately following training (25-point improvement; p < 0.01), with demonstrated retention of knowledge after 6 months (21-point improvement, p < 0.01). Over 350 patients were enrolled in the first 18 months of program initiation. The PEN-Plus clinic led to significant improvement in the provision of medications and testing across a range of services. Conclusion: Mid-level providers can be successfully trained to treat severe NCDs with physician-guided education, mentorship, and supervision. The PEN-Plus clinic improved patient enrollment, the quality of clinical care and access to essential medications and laboratory supplies. These lessons learned can guide decentralization of NCD care to district hospitals in Malawi and expansion of PEN-Plus services in the African region. |
| first_indexed | 2024-04-12T18:46:42Z |
| format | Article |
| id | doaj.art-eda6a8f6b0374ea99e2c040dd3dfac82 |
| institution | Directory Open Access Journal |
| issn | 2214-9996 |
| language | English |
| last_indexed | 2024-04-12T18:46:42Z |
| publishDate | 2022-08-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Annals of Global Health |
| spelling | doaj.art-eda6a8f6b0374ea99e2c040dd3dfac822022-12-22T03:20:36ZengUbiquity PressAnnals of Global Health2214-99962022-08-0188110.5334/aogh.37502779Training Mid-Level Providers to Treat Severe Non-Communicable Diseases in Neno, Malawi through PEN-Plus StrategiesTodd Ruderman0Evelyn Chibwe1Chantelle Boudreaux2Enoch Ndarama3Emily B. Wroe4Emilia Connolly5Gene Bukhman6Partners In Health, NenoPartners In Health, NenoCenter for Integration Science, Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MAMinistry of Health, NenoCenter for Integration Science, Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA; NCD Synergies Project, Partners In Health, Boston, MA; Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MAPartners In Health, Neno, MW; Division of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OHCenter for Integration Science, Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA; NCD Synergies Project, Partners In Health, Boston, MA; Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MABackground: Non-communicable diseases (NCDs) are a leading cause of worldwide morbidity and mortality, yet access to care in lower-income countries is limited. Rural communities, where poverty levels are high, feel the greatest burden. In Malawi, as elsewhere in the African region, it is particularly challenging for patients in rural districts to obtain care for locally endemic and severe NCDs such as type 1 diabetes, rheumatic heart disease, and sickle cell disease. The Package of Essential NCD Interventions – Plus (PEN-Plus) is a strategy to decentralize care for these severe conditions by enabling local clinicians at intermediate-care facilities to provide services otherwise available only through specialty clinics at central hospitals. Objectives: The primary objective of this study was to evaluate the impact of training mid-level providers to treat severe and chronic NCDs in newly established PEN-Plus clinics in Neno, Malawi. Methods: Our team developed a logic model to describe the anticipated impacts of the intervention on provider knowledge, patient recruitment, and care provision. We applied a retrospective review of routinely collected clinical and administrative data to assess changes along these hypothesized pathways. Findings: Didactic trainings improved provider test scores immediately following training (25-point improvement; p < 0.01), with demonstrated retention of knowledge after 6 months (21-point improvement, p < 0.01). Over 350 patients were enrolled in the first 18 months of program initiation. The PEN-Plus clinic led to significant improvement in the provision of medications and testing across a range of services. Conclusion: Mid-level providers can be successfully trained to treat severe NCDs with physician-guided education, mentorship, and supervision. The PEN-Plus clinic improved patient enrollment, the quality of clinical care and access to essential medications and laboratory supplies. These lessons learned can guide decentralization of NCD care to district hospitals in Malawi and expansion of PEN-Plus services in the African region.https://annalsofglobalhealth.org/articles/3750ncdstask shiftingmid-level providersimplementation researchtype 1 diabetesrheumatic heart diseaseheart failuresickle cell disease |
| spellingShingle | Todd Ruderman Evelyn Chibwe Chantelle Boudreaux Enoch Ndarama Emily B. Wroe Emilia Connolly Gene Bukhman Training Mid-Level Providers to Treat Severe Non-Communicable Diseases in Neno, Malawi through PEN-Plus Strategies Annals of Global Health ncds task shifting mid-level providers implementation research type 1 diabetes rheumatic heart disease heart failure sickle cell disease |
| title | Training Mid-Level Providers to Treat Severe Non-Communicable Diseases in Neno, Malawi through PEN-Plus Strategies |
| title_full | Training Mid-Level Providers to Treat Severe Non-Communicable Diseases in Neno, Malawi through PEN-Plus Strategies |
| title_fullStr | Training Mid-Level Providers to Treat Severe Non-Communicable Diseases in Neno, Malawi through PEN-Plus Strategies |
| title_full_unstemmed | Training Mid-Level Providers to Treat Severe Non-Communicable Diseases in Neno, Malawi through PEN-Plus Strategies |
| title_short | Training Mid-Level Providers to Treat Severe Non-Communicable Diseases in Neno, Malawi through PEN-Plus Strategies |
| title_sort | training mid level providers to treat severe non communicable diseases in neno malawi through pen plus strategies |
| topic | ncds task shifting mid-level providers implementation research type 1 diabetes rheumatic heart disease heart failure sickle cell disease |
| url | https://annalsofglobalhealth.org/articles/3750 |
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