Figure 1
Activity components of “Ideal Minimum Integrated Care” for T2D and HTN.
SMES – self-management education and support.
Table 1
Characteristics of study sites based on T2D and HTN activities.
| HEALTH FACILITY | T2D | HTN | NO. OF STAFF TRAINED AND DELIVERING CARE FOR T2D AND HTN | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| NO. OF PEOPLE SCREENED | NO. OF PEOPLE WITH T2D CARED FOR | NO. OF VISITS / CONTACTS | NO. OF PEOPLE SCREENED | NO. OF PEOPLE WITH HTN CARED FOR | NO. OF VISITS / CONTACTS | NURSE | MW | MD | OTHER | TOTAL | |
| Health center (A)* | |||||||||||
| Prey Pnov HC | 50 | ? | ? | 50 | 170 | 850 | 4 | 0 | 0 | 0 | 4 |
| Prey Sneat HC (HSD) | 125 | ? | ? | 0 | 143 | 715 | 2 | 0 | 0 | 1 | 3 |
| Samroang (HSD) | 144 | ? | ? | 0 | 90 | 450 | 2 | 1 | 0 | 0 | 3 |
| Leay Bo HC | 81 | ? | ? | 81 | 72 | 216 | 3 | 0 | 0 | 0 | 3 |
| Health center (B)** | |||||||||||
| Kvav HC | 108 | ? | - | 108 | 49 | 147 | 3 | 0 | 0 | 0 | 3 |
| Reab HC | 850 | ? | 300 | 0 | 145 | 722 | 2 | 2 | 0 | 1 | 5 |
| Kagnchom HC | 403 | 13 | 23 | 403 | 122 | 434 | 4 | 3 | 0 | 0 | 7 |
| Kompong Kdey HC | ? | 31 | 110 | ? | 93 | 462 | 2 | 1 | 1 | 0 | 4 |
| Prey Sleok HC | ? | 52 | 120 | ? | 89 | 264 | 4 | 0 | 0 | 0 | 4 |
[i] *Health center (A): Health center with established PEN, provides screening for CVD, T2D and HTN but treats only HTN.
**Health center(B): Health center with established PEN, provides screening for T2D and HTN and treatment for both conditions.
? number of patients were not documented.
MW – midwife; MD – medical doctor.
Table 2
Epidemiological data used.
| 1. Population Metrics | Value |
| Population in the area | 10,000 |
| % of population age ≥40 years, out of total population | 27% |
| Population age ≥40 years, | 2700 |
| 2. Coverage rate | Value |
| Annual health centre contact rate | 50% |
| 3. Epidemiological Data | |
| Adults >40 years with at least one risk factor for NCDs | 92.30% |
| Low CVD risk (0 to <10%) | 88.00% |
| Medium CVD risk (10 to <20%) | 10.00% |
| High CVD risk (≥20%) | 2.00% |
| Prevalence of HTN in people aged 40 and above | 27.00% |
| Prevalence of Type 2 Diabetes in adults aged 40 and above | 12.00% |
| Ischemic Heart Disease prevalence | 1.72% |
Table 3
Time of health personnel in CVD management cases in minutes.
| SERVICES | TIME PER CASE PER VISIT (MINUTES) | POPULATION NEEDS SERVICE (PERSON) | TIME SPENT IN A YEAR (MINUTES) | ||||
|---|---|---|---|---|---|---|---|
| DOCTOR | NURSE | CHW | DOCTOR | NURSE | CHW | ||
| Screening CVD risk with physical exam | 20 | 5 | 0 | 1246 | 24,921 | 6,230 | 0 |
| First visit- laboratory screening and risk profiling | 10 | 0 | 0 | 1225 | 12,246 | 0 | 0 |
| low risk <10% | 0 | 15 | 0 | 1097 | 0 | 16,448 | 0 |
| Medium Risk CVD 10%–20% | 10 | 30 | 0 | 125 | 1,246 | 3,738 | 0 |
| High Risk CVD >20% | 10 | 30 | 0 | 25 | 249 | 748 | 0 |
| Management of Hypertension | 0 | 0 | 0 | 336 | 0 | 0 | 0 |
| management of diabetic patients | 20 | 60 | 0 | 150 | 2,991 | 8,972 | 0 |
| Community/home visit | 0 | 0 | 80 | 846 | 0 | 0 | 38,877 |
| Annual incremental time (minute) | 41,653 | 36,135 | 38,887 | ||||
| Annual incremental time (hour) | 694 | 602 | 648 | ||||
| Annual incremental time (day) | 87 | 75 | 81 | ||||
Table 4
Annual cost of treatment disaggregated by service in US$.
| SERVICE | HUMAN RESOURCE | LABORATORY | COUNSELLING | MEDICINE | CHW | ANNUAL COST PER CASE |
|---|---|---|---|---|---|---|
| Screening CVD risk with physical exam | 1.03 | 0.31 | – | – | – | 1.34 |
| First visit- laboratory and risk profiling | 0.77 | 8.50 | – | – | – | 9.27 |
| low risk <10% | – | – | 0.62 | – | - | 0.62 |
| Medium Risk CVD 10%-20% | 0.41 | 1.25 | 1.24 | – | – | 2.90 |
| High Risk CVD >20% | 0.41 | 1.25 | 1.24 | – | – | 2.90 |
| Management of Hypertension | – | – | – | 167.90 | – | 167.90 |
| Management of diabetic patients | 0.82 | 16.5 | 2.47 | 49.82 | – | 69.62 |
| Follow up visit and counselling by CHWs | – | – | – | – | 1.71 | 1.71 |
Table 5
Annual total cost to treat 10,000 population at 50% health centre contact per year.
| SERVICES | UNIT COST US$ | NO OF PEOPLE IN NEED OF SERVICE PER 10,000 POP | TOTAL COST PER 10,000 POP US$ |
|---|---|---|---|
| Screening CVD risk with physical exam | 1.34 | 1246 | 1,670.00 |
| First visit- laboratory screening and risk profiling | 9.28 | 1225 | 11,358.00 |
| low risk <10% | 0.62 | 1097 | 678.00 |
| Medium Risk CVD 10%–20% | 2.90 | 125 | 678.00 |
| High Risk CVD >20% | 2.90 | 25 | 72.00 |
| Management of Hypertension | 167.90 | 336 | 56,487.00 |
| management of diabetic patients | 69.62 | 150 | 10,410.00 |
| follow up visit and counselling | 1.71 | 486 | 831.00 |
| Total IMIC provider-side cost | 81,868 | ||
| IMIC provider-side cost per case (Total direct medical cost/Total case) | 66 | ||
| IMIC provider-side cost per capita (Total direct medical cost/Total population in catchment area) | 8 | ||
| Training cost | 752 | ||
| Material to start up the intervention | 1,098 | ||
| Other cost | 805 | ||
| Total cost | 84,523 |