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Implementation of Patient-Centered Education for Chronic-Disease Management in Uganda: An Effectiveness Study
Trishul Siddharthan1,2, Tracy Rabin2, Maureen E Canavan3
1Division of Pulmonary and Critical Care, Johns Hopkins University, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
Background:
The majority of non-communicable disease related deaths occur in low- and middle-income countries. Patient-centered care is an essential component of chronic disease management in high income settings.
Objective:
To examine feasibility of implementation of a validated patient-centered education tool among patients with heart failure in Uganda.
Design:
Mixed-methods, prospective cohort.
Settings:
A private and public cardiology clinic in Mulago National Referral and Teaching Hospital, Kampala, Uganda.
Participants:
Adults with a primary diagnosis of heart failure.
Interventions:
PocketDoktor Educational Booklets with patient-centered health education.
Main Measures:
The primary outcomes were the change in Patient Activation Measure (PAM-13), as well as the acceptability of the PocketDoktor intervention, and feasibility of implementing patient-centered education in outpatient clinical settings. Secondary outcomes included the change in satisfaction with overall clinical care and doctor-patient communication.
Key Results:
A total of 105 participants were enrolled at two different clinics: the Mulago Outpatient Department (public) and the Uganda Heart Institute (private). 93 participants completed follow up at 3 months and were included in analysis. The primary analysis showed improved patient activation measure scores regarding disease-specific knowledge, treatment options and prevention of exacerbations among both groups (mean change 0.94 [SD = 1.01], 1.02 [SD = 1.15], and 0.92 [SD = 0.89] among private paying patients and 1.98 [SD = 0.98], 1.93 [SD = 1.02], and 1.45 [SD = 1.02] among public paying patients, p<0.001 for all values) after exposure to the intervention; this effect was significantly larger among indigent patients. Participants reported that materials were easy to read, that they had improved knowledge of disease, and stated improved communication with physicians.
Conclusions:
Patient-centered medical education can improve confidence in self-management as well as satisfaction with doctor-patient communication and overall care in Uganda. Our results show that printed booklets are locally appropriate, highly acceptable and feasible to implement in an LMIC outpatient setting across socioeconomic groups.
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