Hope for heart, diabetes patients in new plan

A new treatment programme for heart disease and diabetes in western Kenya could turn around patients’  lives, a study has shown.

The programme, that combines treatment with a microfinance intervention, has helped patients stay the treatment course and keep their blood pressure in check.

According to the division of non-communicable diseases at the Health ministry, cardiovascular diseases (CVDs) are a major public health concern. They make up an estimated 25 per cent of hospital admissions countrywide.

Thirteen per cent of autopsies reveal CVDs as a cause of death — representing the second highest cause of mortality after infectious, maternal/perinatal causes.

But, a new research conducted by Moi University School of Medicine - Moi Teaching and Referral Hospital (MTRH) and North American universities could just be the answer.

The study found that addressing and incorporating social stimulus into patients’ healthcare routine to fight poverty and social isolation in the clinical management of blood pressure in Kenya can improve outcomes.

The intervention launched in 2016 involved group medical visits, extending beyond delivery of the typical healthcare services. It was aimed at combating social isolation, increasing social cohesion and improving clinician-patient trust.

Medical Sociologist and Anthropologist Violet Naanyu, who was part of the team studying the programme, said they had been trying to increase access and uptake of care for hypertension and diabetes for three years without success.

Long queues

She said they noted that despite all efforts, a big number of patients could not consistently attend clinics or refill their medication.

“Part of the failed access and inability to continue with follow-ups was due to low knowledge of their conditions, long queues at the health clinics, high transport costs, and high treatment costs, and lack of social support,” she told HealthyNation.

“That’s how the Bridging Income Generation with Group Integrated Care programme in western Kenya was initiated. The aim was to evaluate the impact microfinance and group medical visits would have on cardiovascular risk reduction among individuals with and at increased risk of diabetes,” she said.

For the study, the researchers enrolled at least 2,890 patients with diabetes and hypertension in four subgroups. The first group received the usual chronic disease care, which is multi-component facility-based care consisting of individual visits with a clinician and medication management.

The second group received usual care combined with microfinance initiatives that involved creating community savings groups to pool emergency savings and provide interest-bearing loans for group members in financial need.

The third group received group medical visits, where participants met monthly with a community health worker, a clinician, and other patients with similar health challenges.

The fourth received a combination of group medical visits — where patients with similar medical conditions met together with a clinician and community health worker —  and microfinance interventions. Researchers collected participants' data at baseline, three and 12 months.

After 12 months, 40 per cent of study participants achieved blood pressure control. The greatest results were among patients in the microfinance and group medical visits arms of the study.

Unemployed patients

The group that received combined microfinance and group medical visit interventions registered a 44 per cent greater reduction in systolic blood pressure (SBP) compared to the one that received usual facility-based care. 

Overall, women—who made up 69.9 per cent of the participants —experienced greater blood pressure reductions than men, as did younger people compared to older individuals.

Getting patients into smaller groups based on their locality and choice, and using these groups as education centres and support networks while at the same time delivering both consultation and drug refills was a tactical solution to many of these problems, according to Ms Naanyu.

“Introducing table banking for the groups was a great additional solution to financial strain, moreover, many of them were familiar with table banking in chamas. We have found combining the group-based experience, microfinance, and group medical visits as being a novel approach to non-communicable disease care delivery. This programme has demonstrated beneficial impact,” she said.

“The supportive community formed has had such a big impact that most of the groups have continued with activities, even through Covid-19. A majority of them started meeting at health facilities,” she said.

With nearly two-thirds of the patients unemployed, and more than 75 per cent having an international wealth index of less than 40 — an indicator of poverty, fewer than 17 per cent were enrolled in Kenya's national health national health insurance plan.

The study’s principle investigator and NCD physician at MTRH, Dr Jemima Kamano said: “My take home from this programme is that we must actively keep assessing the challenges facing our patients’ ability to access care, and keep seeking new ways of healthcare delivery that address these challenges, while keeping in mind that a majority of our patients now have long-term diseases requiring lifetime care.”

The combined intervention proved especially beneficial for patients with uncontrolled hypertension at baseline, group medical visits, according to the researchers. They seemingly had benefits that extend beyond hard health outcomes, to combating social isolation, increasing social cohesion, and improving clinician-patient trust.

With NCDs being more and more commonplace in the country, successful interventions like this could serve as a care model for patients throughout the country.

“We know that health outcomes are largely determined by the conditions in which people are born, live and work, along with numerous other socioeconomic factors. The patient population in our study faced significant financial barriers to accessing care, ranging from inadequate health insurance, transportation costs, time lost from work, and myriad other challenges,” said lead researcher Rajesh Vedanthan, a cardiologist and director of the Section for Global Health in the Department of Population Health at NYU Grossman School of Medicine in a report released last month.