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Sustainable Financial Incentives To Improve Prescription Practices For Malaria

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ClinicalTrials.gov Identifier: NCT01809873
Recruitment Status : Completed
First Posted : March 13, 2013
Last Update Posted : March 10, 2015
Sponsor:
Collaborator:
Moi University
Information provided by (Responsible Party):
Duke University

Brief Summary:
This project aims to test an innovative, sustainable financial incentive designed to reduce the number of non-malarial fevers that are treated inappropriately with antimalarial drugs.

Condition or disease Intervention/treatment Phase
Malaria Behavioral: Performance based incentives Not Applicable

Detailed Description:

Global investments in controlling malaria have led to some exciting reductions in the burden of malaria. In some areas, malaria-related deaths have dropped by more than 90%. As malaria transmission declines, a greater fraction of pediatric fevers are from other causes. However, these fevers continue to be treated as malaria, often despite the availability of diagnostic testing. In a typical rural health facility in Kenya, more than 90% of febrile patients are prescribed an antimalarial when no diagnostic tests are available. Even when microscopy or rapid diagnostic tests (RDTs) are available, between 50-80% of patients with a negative test are nonetheless prescribed antimalarials. Inappropriately treated fevers in children can lead to serious consequences for the patient and can accelerate the spread of drug resistance. In addition to the risk to patients, overuse of antimalarials also puts a financial strain on the government health system. Although there is considerable incentive for governments to reduce drug costs and wastage, the financial pressure is not experienced at the appropriate levels of decision-making.

This project aims to test an innovative, sustainable financial incentive designed to reduce the number of non-malarial fevers that are treated inappropriately with antimalarial drugs. The study team will test a financial incentive targeted at the health facility to determine if it improves adherence to diagnostic results and clinical protocols. Eighteen rural health facilities in Western Kenya will be enrolled and randomly allocated to one of two arms. The study team will compare the effectiveness of clinical and technical training in diagnosis of malaria alone (Arm 1) to training plus financial incentives linked to prescription practices (Arm 2) in improving diagnosis and treatment of malaria and non-malaria fevers. The practice of prescribing antimalarials to patients with a negative diagnostic will be compared between facilities with and without the incentive structure. Secondary outcomes will include sensitivity and specificity of routine microscopy at health centers, use of alternative treatments for slide negative fevers, and frequency of stock-outs of antimalarial drugs.

This project will tackle an important implementation research problem. It seeks to test solutions to the problem of poor adherence to evidence-based clinical guidelines for malaria treatment, and thereby reduce inappropriate antimalarial drug use and drug wastage. This project will be conducted in collaboration with Kenya's Division of Malaria Control and avenues to roll-out the intervention, if successful, will be actively explored.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 14862 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Primary Purpose: Health Services Research
Official Title: Sustainable Financial Incentives To Improve Prescription Practices For Malaria
Study Start Date : September 2012
Actual Primary Completion Date : November 2013
Actual Study Completion Date : March 2014

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Malaria

Arm Intervention/treatment
Experimental: Performance based incentives
Performance based incentives: The Incentive arm will receive monthly visits and external quality assurance of malaria diagnostic accuracy, identical to the comparison. Incentive arm will also receive quarterly incentives linked to performance of the facility around six indicators of appropriate malaria case management
Behavioral: Performance based incentives
Facilities enrolled in the intervention arm will receive a financial incentive that is based on their diagnosis and prescription practices for malaria over that quarter. The intervention will last 12 months.

No Intervention: Comparison
The comparison arm will receive monthly visits and monthly external quality assurance of malaria diagnostic accuracy.



Primary Outcome Measures :
  1. Proportion of children under 5 years of age who are treated with antimalarials following a negative malaria test [ Time Frame: At one year post-intervention ]
    The study is designed to detect a reduction in the proportion of children under 5 years of age who are prescribed antimalarials following a negative malaria diagnostic test between the intervention and comparison arms.



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Health facility (level 3) in Western or Rift valley province, within the Academic Model Providing Access to Healthcare (AMPATH) catchment area
  • Consent from Provincial Medical Officer of Health, District Medical Officer of Health and Health facility in-charge
  • Functioning laboratory including microscopic diagnosis of malaria and at least one laboratory technician.

Exclusion Criteria:

  • Lack of consent from any level
  • Lack of adequate laboratory infrastructure or personnel

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01809873


Locations
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Kenya
Moi University
Eldoret, Rift Valley Province, Kenya, 30100
Sponsors and Collaborators
Duke University
Moi University

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Duke University
ClinicalTrials.gov Identifier: NCT01809873     History of Changes
Other Study ID Numbers: Pro00035154
First Posted: March 13, 2013    Key Record Dates
Last Update Posted: March 10, 2015
Last Verified: March 2015

Keywords provided by Duke University:
Malaria
Diagnostics
Health Services

Additional relevant MeSH terms:
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Malaria
Protozoan Infections
Parasitic Diseases