Case management desk guideline, including lifestyle counselling
mHealth training of nurses on the desk guide package
Nurse WhatsApp support group
Supervision of care visits (quarterly)
Digital BP apparatus, glucometer and strips
Treatment cards, used for clinical care (subsequently used also as research data records)
Monthly funds for health workers’ telecommunication fees
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Screen/diagnose
Prescribe antihypertensive
Identify hypertension and/or diabetes and treat
Counsel for lifestyle modification
Follow-up care
Focus group discussion with nurses, month 5
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Provider practice:Screen, diagnose, treat, counsel, follow-up and report as per the case management desk guideline
Patients practice:
Follow-up visits
Treatment
Lifestyle changes as counselled, e.g., healthy eating, activity, smoking cessation
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Patients are:
Screened and diagnosed as per desk guide
Prescribed right drug/ dose
Counselled for life-style change
Followed-up and treated, that is, continuing care
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