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Table 2 Effectiveness indicator results

From: MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework

  Result or comment
a. Clinical Outcome Indicators
 % ≥ 0.5 mmol/L reduction in total cholesterol from enrolment to last visit (those enrolled > = 90 days) Among those with a cholesterol test who were in the cohort for at least 90 days (2585), 651 had ≥ reduction of 0.5 mmol/L in total cholesterol = 25.1%
 % patients with asthma free from exacerbations/ admissions in previous 6 months Among 382 patients with asthma, only 25 recorded exacerbations in total during the 3-year study period.
 % patients who report decreased/quitting smoking Not available as self-reported smoking category (stopped, decreased, increased, resumed, unchanged) was reported relative to the last appointment.
 % patients who report increased levels of exercise from baseline At each visit the category (active, inactive, moderately active, and moderately inactive) for recent activity behaviour was recorded. 3347 patients enrolled in the project at least 90 days had a first and last measurement. 610 (18.2%) had improved activity. 593 (17.7%) had worse activity. 2144 (64.1%) stayed the same. There was no significant improvement (chi sq. =0.284, p = 0.594).
 Trend in referrals to another facility for acute complications/specialist care (% of active cohort) Trend in referral by type of referral service and volume of referrals were analysed
b. Quality (Process) Indicators
 % recommended referrals to other services that are appropriate as per guideline Not tested
 % of active patients with CVDa prescribed a statin N = 369 (25.8%)
 % of patients with CVDa prescribed aspirin N = 717 (50.1%)
 % of patients with CVDa prescribed at least one anti-hypertensiveb drug N = 1007 (70.4%)
 % of patients with asthmac with inhaler technique check documented N = 48 (94%)
 No./% of times when appropriate clinical action taken based on clinical or laboratory findings Among 130 randomly audited diabetic patient files, 100% had cholesterol checked; 73.8% (n = 82) had a CVD risk score subsequently calculated. Of these, 65.9% had a statin correctly prescribed (or not prescribed) according to MSF guidelinesd.
 Description of cohort deaths 2.6% (n = 139) of enrolled patients died by end of study period. Deaths were determined by word of mouth and a defaulter survey. Among all exitede patients deaths accounted for 9.3% (139 of 1489 exits).
  1. a1431 patients with new or established CVD were ever enrolled during the study period
  2. bIncluding: amlodipine, atenolol, bisoprolol, enalapril, hydrochlorothiazide, valsartan; excluding: exclusively frusemide or spironolactone
  3. cAmong 51 asthma patients randomly selected for clinical audit
  4. dTechnically, the MSF guideline did not require cholesterol testing to be performed before calculating a CVD risk score, but qualitative data confirmed most clinicians waited for cholesterol results before calculating it
  5. eExited patients refers to those that were known to have died, were lost to follow up despite efforts to trace them or who had informed the team that they would no longer be attending the MSF service