Implementation of Patient-Centered Education for Chronic-Disease Management in Uganda: An Effectiveness Study

BackgroundThe 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.ObjectiveTo examine feasibility of implementation of a validated patient-centered education tool among patients with heart failure in Uganda.DesignMixed-methods, prospective cohort.SettingsA private and public cardiology clinic in Mulago National Referral and Teaching Hospital, Kampala, Uganda.ParticipantsAdults with a primary diagnosis of heart failure.InterventionsPocketDoktor Educational Booklets with patient-centered health education.Main MeasuresThe 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 ResultsA 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, pConclusionsPatient-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.研究背景：绝大多数与非传染性疾病相关的死亡病例发生在中低收入国家（low- and middle-income countries）。以患者为中心的照护是高收入地区慢性疾病管理的核心组成部分。 研究目标：本研究旨在评估在乌干达心力衰竭患者中应用经过验证的以患者为中心的教育工具的可行性。 研究设计：混合方法前瞻性队列研究。 研究场景：乌干达坎帕拉穆拉戈国家转诊教学医院的公立与私立心血管门诊。 研究对象：经初步诊断为心力衰竭的成年患者。 干预措施：搭载以患者为中心的健康教育内容的PocketDoktor教育手册。 主要测量指标：主要结局指标包括患者激活量表（Patient Activation Measure, PAM-13）的得分变化、PocketDoktor干预的可接受性，以及在门诊临床场景中实施以患者为中心的教育的可行性。次要结局指标包括患者对整体临床照护的满意度变化，以及医患沟通满意度变化。 主要研究结果：共计105名研究对象在两家门诊纳入本研究：分别为穆拉戈门诊（公立）与乌干达心脏研究所（私立）。最终有93名研究对象完成了3个月随访并纳入数据分析。主要分析结果显示，两组患者在疾病相关知识、治疗方案选择以及病情恶化预防方面的患者激活量表得分均有所提升：自费患者的得分变化分别为均差0.94（标准差SD=1.01）、1.02（SD=1.15）与0.92（SD=0.89）；公费患者的得分变化分别为1.98（SD=0.98）、1.93（SD=1.02）与1.45（SD=1.02），p 研究结论：在乌干达，以患者为中心的医学教育可提升患者的自我管理信心，同时改善其对医患沟通与整体临床照护的满意度。本研究结果表明，纸质手册在中低收入国家（LMIC）的门诊场景中具有地域适配性，且在不同社会经济群体中均具备较高的可接受性与实施可行性。