Abstract
BACKGROUND AND AIMS: Non-communicable diseases (NCDs), particularly hypertension and type 2 diabetes mellitus, represent a major public health burden in Palestine. The World Health Organization's Package of Essential Non-Communicable Disease Interventions (PEN) was introduced to strengthen primary healthcare services in low-resource settings. However, evidence on its association with patient-level clinical outcomes in Palestine remains limited. This study aimed to assess the association between PEN implementation and clinical outcomes, including blood pressure, glycemic control, and disease-related complications. METHODS: A comparative cross-sectional study was conducted across 18 primary healthcare clinics in Hebron, Palestine, between February and May 2025. A total of 440 patients (220 receiving PEN-based care and 220 receiving conventional care) were recruited using convenience sampling. Data were collected through structured questionnaires and clinical records. Bivariate analyses were performed using Mann-Whitney U and χ (2) tests. Multivariable logistic and linear regression models were used to adjust for potential confounders. Effect estimates were reported as adjusted odds ratios (AOR) and beta coefficients (β) with 95% confidence intervals (CI). RESULTS: Patients receiving PEN-based care had lower systolic blood pressure (mean difference -2.93 mmHg; β = -2.93, 95% CI [ - 5.61, -0.25], p = 0.032) and lower HbA1C levels (β = -0.42, 95% CI [ - 0.78, -0.06], p = 0.021) compared with conventional care, although the absolute difference in HbA1C was small. Fasting blood glucose was substantially lower in the PEN group (mean difference -30.15 mg/dL, p < 0.001). The PEN approach was associated with higher odds of controlled blood pressure (AOR = 1.78, 95% CI [1.15, 2.74]) and HbA1C (AOR = 1.64, 95% CI [1.05, 2.56]), and lower odds of complications (AOR = 0.52, 95% CI [0.34, 0.79]). Patients in the PEN group also reported significantly higher healthcare utilization and adherence indicators. CONCLUSION: The PEN approach was associated with modest improvements in clinical outcomes, reduced complications, and enhanced healthcare utilization among patients with hypertension and diabetes in primary care settings. However, given the cross-sectional design, these findings should be interpreted as associations rather than causal effects. Further longitudinal and experimental studies are required to confirm these findings and evaluate long-term impact.