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Screening for Non-communicable Diseases at a Walk-in Clinic in Trinidad, West Indies: A Time-motion Cross-sectional Study and Net Present Value Analysis

Issue: 
DOI: 
10.7727/wimj.2015.277

ABSTRACT

Objective: The overall aim of this study was to determine the feasibility of recommending a screening process for non-communicable diseases (NCDs) and their risk factors, as a national and regional model.

Methods: A cross-sectional, six-station process was carried out. It consisted of the invitation and consent, history (personal and family history of NCDs), biometrics (waist circumference, BMI), blood levels (lipids and HbA1c) and urinalysis (microalbuminuria), basic examinations (BP, peripheral neuropathy, presence of acanthosis nigricans and visual acuity) and an exit interview of the participants. Net Present Value (NPV) calculations were carried out for very the high risk patients (defined as a > 30% risk of a cardiovascular event (limb amputation) in the next ten years) for two discount rates of 0.75% (US) and 3.4% (Trinidad and Tobago).

Results: A convenience sample of 514 walk-in patients (56.2% recruitment rate) was screened, ~23 patients per day. The median time for a patient attending all the stations was 21 minutes (Range 11-59 minutes). Of the six stations, the laboratory was the lengthiest, median 10 minutes (Range 2-50 minutes). The entire project cost USD $20 439 (USD $39.76 per patient). Between one and seven very high risk patients (three sub-groups of patients had this risk profile) were identified. The cost of identifying a very high risk patient ranged from USD $2907 to USD $20 349. The NPV of identifying these high risk patients ranged from -$6748 to $14 725 and was favourable for three of the four monetary scenarios.

Conclusion: A six-station process to provide rapid screening of walk-in patients for NCDs is feasible and provides monetary value in three of the four scenarios in a Caribbean setting. 

Accepted: 
03 Jan, 2017
Revised: 
05 Dec, 2016
e-Published: 12 Jan, 2017

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