Domestic health visiting: an innovative approach to bridge Gaps in epilepsy care in Laos and Cambodia.
Résumé
Objective:
Epilepsy is a major neurological disorder and of particular relevance to Asia, as demonstrated recently (D Bhalla).
The biggest challenge in epileptology lie in finding approach(s) that may effectively bridge the gaps in epilepsy care. Here, we present an innovative mechanism, named domestic health visiting (DHV), developed (D Bhalla) for increasing the access to care for those with epilepsy in two Asian countries-Laos and Cambodia.
Methods:
This is a novel bi-centric interventional project being conducted in Laos and Cambodia. In each country, two sites (districts) are chosen, one being an interventional site (IS) and another being non-interventional site (NIS). In Laos the project locations are Pakgnum (IS) and Naxaythong and Sangthong (NIS). In Cambodia the project locations are Memot (IS) and O Reang Ov district (NIS). In IS, the intervention is DHV by domestic health
visitors (DHv) through which population would be screened.
Those screened would undergo diagnostic consultation at primary health centers (PHCs) by trained district hospital doctors.
DHv would deliver treatment at-home at frequent intervals along- with counseling and education of the patients. NIS would solely undergo mass-media through radio. In NIS, screening, diagnosis, treatment, and therapeutic follow-ups would be conducted upon an individual’s visit at PHCs & district hospitals which is the usual practice in these countries. At the end of 18-month follow up, various endpoints will be evaluated for possible changes between IS vs NIS and baseline vs final-line. The procedures that are being followed are given below.
Footnotes:
DH: District Hospital; DD: District doctors; Dx: Diagnosis, HR: Human resources, KAP: Knowledge attitude practice, PHCs: Primary health centers.
Results:
This is one of the very few examples where a public health program (with research aspects also) on epilepsy is being
carried-out with Ministry of Health as one of the primary implementers. The benefits are aimed to go beyond people with epilepsy alone and touch upon service-providers (e.g. increased consultation) as well as health care system (e.g. trained staff and facilities). The precise variables that we are estimating a change are: Differences in the: – Total number of people that get screened (captured, identified) – Total number of people that get identified
with epilepsy – Total number of contacts (± contact hours) made between public and system – Total number of people that get treated during overall period – Total quantity of medicines used – Time to premature rupture of treatment – Treatment compliance – Premature mortality – Self-reported satisfaction with treatment – Difference in seizure frequency – Cost per-attendance
Descriptive: – Number of epilepsy-compliant service facilities – Number of epilepsy trained human resource – Patient savings (in terms of negotiated price) – Increased political visibility – Availability of training material – Availability of public awareness materials – Number of people reached through mass-media.
Conclusion:
The conclusion that we anticipate is that DHV becomes an effective and cost-conscious strategy to reduce diagnostic, treatment as well as the therapeutic follow-up gaps among people with epilepsy in Cambodia and Laos.