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

Abstract

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.</div