TY - JOUR T1 - Designing and implementing an integrated non-communicable disease primary care intervention in rural Nepal JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2018-001343 VL - 4 IS - 2 SP - e001343 AU - Anirudh Kumar AU - Dan Schwarz AU - Bibhav Acharya AU - Pawan Agrawal AU - Anu Aryal AU - Nandini Choudhury AU - David Citrin AU - Binod Dangal AU - Grace Deukmedjian AU - Meghnath Dhimal AU - Santosh Dhungana AU - Bikash Gauchan AU - Tula Gupta AU - Scott Halliday AU - Dhiraj Jha AU - SP Kalaunee AU - Biraj Karmacharya AU - Sandeep Kishore AU - Bhagawan Koirala AU - Lal Kunwar AU - Ramesh Mahar AU - Sheela Maru AU - Stephen Mehanni AU - Isha Nirola AU - Sachit Pandey AU - Bhaskar Pant AU - Mandeep Pathak AU - Sanjaya Poudel AU - Irina Rajbhandari AU - Anant Raut AU - Pragya Rimal AU - Ryan Schwarz AU - Archana Shrestha AU - Aradhana Thapa AU - Poshan Thapa AU - Roshan Thapa AU - Lena Wong AU - Duncan Maru Y1 - 2019/04/01 UR - http://gh.bmj.com/content/4/2/e001343.abstract N2 - Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care—first-contact access, care coordination, comprehensiveness and continuity—offer practical, high-quality design options for non-communicable disease care in low-income and middle-income countries. We describe an integrated non-communicable disease intervention in rural Nepal using the 4C principles. We present 18 months of retrospective assessment of implementation for patients with type II diabetes, hypertension and chronic obstructive pulmonary disease. We assessed feasibility using facility and community follow-up as proxy measures, and assessed effectiveness using singular ‘at-goal’ metrics for each condition. The median follow-up for diabetes, hypertension and chronic obstructive pulmonary disease was 6, 6 and 7 facility visits, and 10, 10 and 11 community visits, respectively (0.9 monthly patient touch-points). Loss-to-follow-up rates were 16%, 19% and 22%, respectively. The median time between visits was approximately 2 months for facility visits and 1 month for community visits. ‘At-goal’ status for patients with chronic obstructive pulmonary disease improved from baseline to endline (p=0.01), but not for diabetes or hypertension. This is the first integrated non-communicable disease intervention, based on the 4C principles, in Nepal. Our experience demonstrates high rates of facility and community follow-up, with comparatively low lost-to-follow-up rates. The mixed effectiveness results suggest that while this intervention may be valuable, it may not be sufficient to impact outcomes. To achieve the Sustainable Development Goals, further implementation research is urgently needed to determine how to optimise non-communicable disease interventions. ER -