INTRODUCTION:
A chronic disease or condition is typically defined as one that lasts more than three months. Both communicable and non-communicable diseases can be considered as chronic conditions if they last for a long time. High blood pressure, diabetes, heart disease, drug addiction, tuberculosis, mental illness, bone disease, any kind of injury, and pain are some of the examples of chronic diseases. A person is referred to as having multiple long term conditions if they have two or more of the above diseases. The burden of Multiple Long Term Condition (MLTC) is increasing in Nepal with prevalence in Nepal at 14% in (>60 years). Our country do not currently address MLTC holistically. Hence, there is an urgent need to develop and implement new context-specific, patient-centered, equitable, resource-sensitive, integrated management strategies with a continuum of care approach.
The Global Health Research Centre (GHRC) for MLTC project plans to enhance the care of people with multiple long-term conditions through community engagement and digital intervention such as telemedicine and electronic decision support systems (EDSS). It is being done in 4 districts (Kathmandu, Bhaktapur, Lalitpur, and Kavre) of Nepal and in India. This five-year project is being conducted in Nepal under the leadership of Kathmandu Medical College. It is being funded by National Institute of Health and Care Research (NIHR) and led by Public Health Foundation of India, the University of Leicester (UK).
Our aim is to improve the care for people suffering from MLTC through innovative health system level interventions. We will do this by meaningfully engaging patients, their communities, and other relevant stakeholders. We will use their views to co-design a person or patient-centered care model that works for them and will train healthcare workers accordingly.
Our work is divided into short, medium, and long-term targets.
Formative phase:
To identify common clusters of chronic conditions among adults in selected communities and health facilities, their socio-economic characteristics, behavioral risk factors and physical and mental wellbeing;
To assess readiness and service availability for MLTCs in selected health facilities;
To conduct comprehensive community engagement and involvement activities to identify challenges, outcomes and design solutions for people living with MLTCs, their caregivers and community health workers; and
To systematically review best-practice continuum of care models for MLTCs and barriers, enablers, disparities and drivers to implement health system interventions.
Development & Piloting Phase:
To co-design health system interventions including CEDSS, assisted telemedicine and patient-facing application; and
To conduct pilot trial to assess feasibility, fidelity, acceptability and costs of health system interventions including CEDSS, assisted telemedicine and patient-facing application.
Intervention Phase:
To conduct a definitive cluster randomized controlled trial (cRCT) to assess the effectiveness and cost-effectiveness of co-designed health system intervention as compared to usual care for PLWMLTCs.
In the long term, we will work with the governments of India and Nepal to address MLTC, embed the care model in respective health systems to improve health outcomes. Findings and materials developed by this collaboration will be widely disseminated and shared to improve the quality of lives of people suffering from MLTC, strengthen the health systems, and benefit societies and national economies.
