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Sever MŞ, Vanholder R, Lameire N. Disaster preparedness for people with kidney disease and kidney healthcare providers. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00176. [PMID: 39046087 DOI: 10.1097/mnh.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
PURPOSE OF REVIEW Man-made and natural disasters become more frequent and provoke significant morbidity and mortality, particularly among vulnerable people such as patients with underlying kidney diseases. This review summarizes strategies to minimize the risks associated with mass disasters among kidney healthcare providers and patients affected by kidney disease. RECENT FINDINGS Considering patients, in advance displacement or evacuation are the only options to avoid harmful consequences of predictable disasters such as hurricanes. Following unpredictable catastrophes, one can only rely upon educational initiatives for disaster risk mitigation. Preparatory initiatives before disasters such as training courses should target minimizing hazards in order to decrease morbidity and mortality by effective interventions during and early after disasters. Retrospective evaluation of previous interventions is essential to identify adverse consequences of disaster-related health risks and to assess the efficacy of the medical response. However, preparations and subsequent responses are always open for ameliorations, even in well developed countries that are aware of disaster risks, and even after predictable disasters. SUMMARY Adverse consequences of disasters in patients with kidney diseases and kidney healthcare providers can be mitigated by predisaster preparedness and by applying action plans and pragmatic interventions during and after disasters. Preparing clear, practical and concise recommendations and algorithms in various languages is mandatory.
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Affiliation(s)
- Mehmet Şükrü Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels
- Nephrology Section, Department of Internal Medicine and, Paediatrics
| | - Norbert Lameire
- Renal Division, Department of Medicine, University Hospital Ghent, Ghent, Belgium
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2
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Mahapatra P, Sahoo KC, Pati S. A longitudinal qualitative study on physician experience in managing multimorbidity across the COVID-19 pandemic in Odisha, India. Sci Rep 2024; 14:12866. [PMID: 38834635 DOI: 10.1038/s41598-024-60473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/23/2024] [Indexed: 06/06/2024] Open
Abstract
While many studies have documented adverse impact of multiple chronic conditions or multimorbidity on COVID-19 outcomes in patients, there is scarcity of report on how physicians managed these patients. We investigated the experiences and challenges of clinicians in managing patients with multimorbidity throughout the COVID-19 pandemic in Odisha state, India. To understand the factors influencing illness management and the adaptive responses of physicians alongside the evolving pandemic, we followed a longitudinal qualitative study design. Twenty-three physicians comprising general practitioners, specialists, and intensivists, were telephonically interviewed in-depth. Saldana's longitudinal qualitative data analysis method was employed for data analysis. COVID-19 pandemic initially diverted the attention of health systems, resulting in reduced care. With time, the physicians overcame fear, anxiety, and feelings of vulnerability to COVID-19 and started prioritising patients with multimorbidity for treatment and vaccination. All physicians recommended teleconsultation and digital health records to benefit chronic illness care during future public health crises. The findings underscore the transformative potential of physician resilience and adaptation during the COVID-19 pandemic, emphasizing the importance of prioritizing patients with multimorbidity, incorporating teleconsultation, and implementing digital health records in healthcare systems to enhance chronic illness care and preparedness for future public health crises.
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Affiliation(s)
- Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Krushna Chandra Sahoo
- Department of Health Research, Health Technology Assessment in India (HTAIn), Ministry of Health and Family Welfare, New Delhi, 110001, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre Bhubaneswar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India.
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3
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Vijayasingham L, Ansbro É, Zmeter C, Abbas LA, Schmid B, Sanga L, Larsen LB, Perone SA, Perel P. Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings. J Migr Health 2024; 9:100228. [PMID: 38577626 PMCID: PMC10992697 DOI: 10.1016/j.jmh.2024.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.
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Affiliation(s)
- Lavanya Vijayasingham
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Éimhín Ansbro
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carla Zmeter
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Linda Abou Abbas
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Benjamin Schmid
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Leah Sanga
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | | | - Sigiriya Aebischer Perone
- International Committee for the Red Cross (ICRC), Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Pablo Perel
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
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4
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Lohana AC, Gulati A, Kumar J, Shivani F, Kumar D. The Silent Victims: How the Israel-Palestine War Impacts the Management of Chronic Kidney Disease and End-Stage Renal Disease Patients. Cureus 2024; 16:e55488. [PMID: 38571837 PMCID: PMC10989711 DOI: 10.7759/cureus.55488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
This article discusses the multifaceted impact of wars and armed conflicts on healthcare systems, with a focus on the Israel-Palestine war and its consequences for individuals with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The war has severely disrupted healthcare infrastructure, leading to damage or destruction of hospitals and clinics, shortages in medical supplies and staff, and interruptions in the delivery of essential services. This disruption poses significant challenges for the management of chronic conditions such as CKD and ESRD, where patients rely on regular and specialized care. The article highlights the logistical challenges and health risks faced by these patients, including the interruption of dialysis treatment, shortages of medications, and the impact of displacement on continuity of care. It also addresses the psychological toll on patients, emphasizing the increased stress, anxiety, and depression that can exacerbate their condition. The need for international aid and humanitarian efforts to support CKD and ESRD patients in conflict zones is underscored, along with the importance of addressing the root causes of the conflict to ensure the well-being of vulnerable populations.
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Affiliation(s)
- Abhi C Lohana
- Department of Internal Medicine, West Virginia University/Camden Clark Medical Center, Parkersburg, USA
| | - Amit Gulati
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jatender Kumar
- Department of Internal Medicine, Brookdale University Hospital Medical Center, New York, USA
| | - Fnu Shivani
- Department of Internal Medicine, Ascension Saint Joseph, Chicago, USA
| | - Danesh Kumar
- Department of Internal Medicine, Henry Ford Jackson Hospital, Jackson, USA
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Willis R, Akik C, El-Dirani Z, Truppa C, Zmeter C, Fleri F, Perone SA, Paci R, Frederiksen S, Haidar CA, Hamadeh RS, Fouad FM, Perel P, Roberts B, Ansbro É. Patient experiences of diabetes and hypertension care during an evolving humanitarian crisis in Lebanon: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001383. [PMID: 38055706 DOI: 10.1371/journal.pgph.0001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/19/2023] [Indexed: 12/08/2023]
Abstract
Humanitarian health care models increasingly incorporate care for non-communicable diseases (NCDs). Current research evidence focuses on burden of disease, service provision and access to care, and less is known about patient's experience of the continuum of care in humanitarian settings. To address this gap, this study explored experiences of displaced Syrian and vulnerable Lebanese patients receiving care for hypertension and/or diabetes at four health facilities supported by humanitarian organisations in Lebanon. We conducted in-depth, semi-structured qualitative interviews with a purposive sample of patients (n = 18) and their informal caregivers (n = 10). Data were analysed thematically using both deductive and inductive approaches. Both Syrian and Lebanese patients reported interrupted pathways of care. We identified three typologies of patient experience at the time of interview; (1) managing adequately from the patient's perspective; (2) fragile management and (3) unable to manage their condition(s) adequately, with the majority falling into typologies 2 and 3. Patients and their families recognised the importance of maintaining continuity of care and self-management, but experienced substantial challenges due to changing availability and cost of medications and services, and decreasing economic resources during a period of national crises. Family support underpinned patient's response to challenges. Navigating the changing care landscape was a significant burden for patients and their families. Interactions were identified between mental health and NCD management. This study suggests that patients experienced disrupted, non-linear pathways in maintaining care for hypertension and diabetes in a humanitarian setting, and family support networks were key in absorbing treatment burden and sustaining NCD management. Recommendations are made to reduce treatment burden for patients and their families and to support sustainable condition management.
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Affiliation(s)
- Ruth Willis
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chaza Akik
- Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Zeinab El-Dirani
- Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Claudia Truppa
- International Committee of the Red Cross, Beirut, Lebanon
| | - Carla Zmeter
- International Committee of the Red Cross, Beirut, Lebanon
| | - Fabrizio Fleri
- International Committee of the Red Cross, Beirut, Lebanon
| | - Sigiriya Aebischer Perone
- International Committee of the Red Cross, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | | | | | - Randa S Hamadeh
- Primary Healthcare and Social Health Department, Ministry of Public Health, Lebanon
| | - Fouad M Fouad
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Lebanon
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bayard Roberts
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Éimhín Ansbro
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Wang X, Zheng C, Wang Y, Birch S, Huang Y, Valentijn P. Patients' and Care Professionals' Evaluation of the Effect of a Hospital Group on Integrated Care in Chinese Urban Health Systems: A Propensity Score Matching and Difference-in-differences Regression Approach. Int J Health Policy Manag 2023; 12:7897. [PMID: 38618775 PMCID: PMC10843371 DOI: 10.34172/ijhpm.2023.7897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/28/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND A hospital group is an organizational integration strategy that has recently been widely implemented in Chinese urban health systems to promote integrated care. This study aims to evaluate the effect of hospital group on integrated care from the perspectives of both patients and care professionals. METHODS Two cross-sectional surveys were conducted in Shenzhen city of China, in June 2018 and July 2021. All thirty Community Health Stations (CHSs) in the hospital group were included in the intervention group, with 30 CHSs in the same district selected as the control group by simple random sampling. All care professionals within both the intervention and the control groups were invited to participate in the surveys. Twelve CHSs were selected from 30 CHSs in the intervention and the control groups by simple random sampling, and 20 patients with type 2 diabetes mellitus (T2DM) were selected from each of these selected CHSs to participate in the survey by systematic sampling. The Rainbow Model of Integrated Care-Measurement Tool (Chinese version) was used to assess integrated care. Propensity score matching and difference-in-differences regression (PSM-DID) were used to evaluate the effect of the hospital group on integrated care. RESULTS After matching, 528 patients and 1896 care professionals were included in the DID analysis. Results from care professionals indicated that the hospital group significantly increased technical competence of the health system by 0.771 points, and cultural competence by 1.423 points. Results from patients indicated that the hospital group significantly decreased organizational integration of the health system by 0.649 points. CONCLUSION The results suggests that the effect of the hospital group on integrated care over and above routine strategies for integrated care is limited. Therefore, it is necessary to pay attention to implementing professional, clinical and other integration strategies beyond establishing hospital groups, in urban Chinese health systems.
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Affiliation(s)
- Xin Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Caiyun Zheng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yao Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, Australia
| | - Yixiang Huang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Pim Valentijn
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, The Netherlands
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Ratnayake R, Rawashdeh F, AbuAlRub R, Al-Ali N, Fawad M, Bani Hani M, Zoubi S, Goyal R, Al-Amire K, Mahmoud R, AlMaaitah R, Parmar PK. Rapidly adapted community health strategies to prevent treatment interruption and improve COVID-19 detection for Syrian refugees and the host population with hypertension and diabetes in Jordan. Int Health 2023; 15:664-675. [PMID: 36576492 PMCID: PMC10629964 DOI: 10.1093/inthealth/ihac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We evaluated community health volunteer (CHV) strategies to prevent non-communicable disease (NCD) care disruption and promote coronavirus disease 2019 (COVID-19) detection among Syrian refugees and vulnerable Jordanians, as the pandemic started. METHODS Alongside medication delivery, CHVs called patients monthly to assess stockouts and adherence, provide self-management and psychosocial support, and screen and refer for complications and COVID-19 testing. Cohort analysis was undertaken of stockouts, adherence, complications and suspected COVID-19. Multivariable models of disease control assessed predictors and non-inferiority of the strategy pre-/post-initiation. Cost-efficiency and patient/staff interviews assessed implementation. RESULTS Overall, 1119 patients were monitored over 8 mo. The mean monthly proportion of stockouts was 4.9%. The monthly proportion non-adherent (past 5/30 d) remained below 5%; 204 (18.1%) patients had complications, with 63 requiring secondary care. Mean systolic blood pressure and random blood glucose remained stable. For hypertensive disease control, age 41-65 y (OR 0.46, 95% CI 0.2 to 0.78) and with diabetes (OR 0.73, 95% CI 0.54 to 0.98) had decreased odds, and with baseline control had increased odds (OR 3.08, 95% CI 2.31 to 4.13). Cumulative suspected COVID-19 incidence (2.3/1000 population) was suggestive of ongoing transmission. While cost-efficient (108 US${\$}$/patient/year), funding secondary care was challenging. CONCLUSIONS During multiple crises, CHVs prevented care disruption and reinforced COVID-19 detection.
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Affiliation(s)
- Ruwan Ratnayake
- International Rescue Committee, Jordan Office, Amman, 11183, Jordan
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Fatma Rawashdeh
- International Rescue Committee, Jordan Office, Amman, 11183, Jordan
| | - Raeda AbuAlRub
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Ar-Ramtha, 22110, Jordan
| | - Nahla Al-Ali
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Ar-Ramtha, 22110, Jordan
| | - Muhammad Fawad
- International Rescue Committee, Jordan Office, Amman, 11183, Jordan
| | | | - Saleem Zoubi
- International Rescue Committee, Jordan Office, Amman, 11183, Jordan
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, 92093, USA
| | | | - Refqi Mahmoud
- Division of Cardiovascular Disease, Jordanian Ministry of Health, Amman, Jordan
| | - Rowaida AlMaaitah
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Ar-Ramtha, 22110, Jordan
| | - Parveen K Parmar
- Keck School of Medicine, University of Southern California, Los Angeles, California, 90033, USA
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Sever MS, Luyckx V, Tonelli M, Kazancioglu R, Rodgers D, Gallego D, Tuglular S, Vanholder R. Disasters and kidney care: pitfalls and solutions. Nat Rev Nephrol 2023; 19:672-686. [PMID: 37479903 DOI: 10.1038/s41581-023-00743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/23/2023]
Abstract
Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.
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Affiliation(s)
- Mehmet Sukru Sever
- Istanbul University, Istanbul School of Medicine, Department of Nephrology, Istanbul, Turkey.
| | - Valerie Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard, Medical School, Boston, MA, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rumeyza Kazancioglu
- Division of Nephrology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Darlene Rodgers
- Independent Nurse Consultant, American Society of Nephrology, Washington, DC, USA
| | - Dani Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patient Federation, Wien, Austria
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
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Almeida PFD, Casotti E, Silvério RFL. Care trajectories of COVID-19 patients: from preventive measures to rehabilitation. CAD SAUDE PUBLICA 2023; 39:e00163222. [PMID: 36820728 DOI: 10.1590/0102-311xpt163222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/09/2023] [Indexed: 02/19/2023] Open
Abstract
This study aims to analyze the care trajectories of patients diagnosed with COVID-19 who were hospitalized and are currently undergoing rehabilitation regarding their use of and access to the healthcare network (HN). An evaluative, qualitative study was carried out based on interviews with patients in the city of Niterói, Rio de Janeiro State, Brazil. The care trajectories were reconstructed at three different occasions that express their experiences with the healthcare and support network during the pandemic: prevention, support and diagnosis measures; hospitalization; post-COVID-19 care, rehabilitation and support. The results indicate that the main source of information about COVID-19 was TV newscasts. Preventive hygiene measures were the most widely adopted. The family was the main support network. There was no waiting time for admission to the municipal referral hospital. Hospitalization was very well evaluated in terms of user embracement, multidisciplinary care, virtual visits and daily contact between doctor and family members. A post-discharge "care vacuum" was identified, with no follow-up by primary health care (PHC) and other public services. Low-cost health insurance plans and private specialized post-COVID-19 services were frequently and spontaneously sought until the implementation of the rehabilitation service. In summary, solitary and discontinuous care trajectories of individuals and families shed light on several challenges to the health system, including guaranteed access to coordinated PHC and expanded offer of specialized public services and rehabilitation, aligned with the principles of humanized care, in addition to the maintenance of social support measures.
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Affiliation(s)
| | - Elisete Casotti
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brasil
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10
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Precision public-health intervention for care coordination: a real-world study. Br J Gen Pract 2023; 73:e220-e230. [PMID: 36823048 PMCID: PMC9923768 DOI: 10.3399/bjgp.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/11/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Health emergencies disproportionally affect vulnerable populations. Digital tools can help primary care providers find, and reach, the right patients. AIM To evaluate whether digital interventions delivered directly to GPs' clinical software were more effective at promoting primary care appointments during the COVID-19 pandemic than interventions delivered by post. DESIGN AND SETTING Real-world, non-randomised, interventional study involving GP practices in all Australian states. METHOD Intervention material was developed to promote care coordination for vulnerable older veterans during the COVID-19 pandemic, and sent to GPs either digitally to the clinical practice software system or in the post. The intervention material included patient-specific information sent to GPs to support care coordination, and education material sent via post to veterans identified in the administrative claims database. To evaluate the impact of intervention delivery modalities on outcomes, the time to first appointment with the primary GP was measured; a Cox proportional hazards model was used, adjusting for differences and accounting for pre-intervention appointment numbers. RESULTS The intervention took place in April 2020, during the first weeks of COVID-19 social distancing restrictions in Australia. GPs received digital messaging for 51 052 veterans and postal messaging for 26 859 veterans. The digital group was associated with earlier appointments (adjusted hazard ratio 1.38 [1.34 to 1.41]). CONCLUSION Data-driven digital solutions can promote care coordination at scale during national emergencies, opening up new perspectives for precision public-health initiatives.
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Shortland T, McGranahan M, Stewart D, Oyebode O, Shantikumar S, Proto W, Malik B, Yau R, Cobbin M, Sabouni A, Rudge G, Kidy F. A systematic review of the burden of, access to services for and perceptions of patients with overweight and obesity, in humanitarian crisis settings. PLoS One 2023; 18:e0282823. [PMID: 37093795 PMCID: PMC10124894 DOI: 10.1371/journal.pone.0282823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 02/23/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Excess body weight causes 4 million deaths annually across the world. The number of people affected by humanitarian crises stands at a record high level with 1 in 95 people being forcibly displaced. These epidemics overlap. Addressing obesity is a post-acute phase activity in non-communicable disease management in humanitarian settings. Information is needed to inform guidelines and timing of interventions. The objective of this review was to explore the prevalence of overweight and obesity in populations directly affected by humanitarian crises; the cascade of care in these populations and perceptions of patients with overweight and obesity. METHODS Literature searches were carried out in five databases. Grey literature was identified. The population of interest was non-pregnant, civilian adults who had experience of humanitarian crises (armed conflict, complex emergencies and natural disasters). All study types published from January 1st, 2011, were included. Screening, data extraction and quality appraisal were carried out in duplicate. A narrative synthesis is presented. RESULTS Fifty-six reports from forty-five studies were included. Prevalence estimates varied widely across the studies and by subgroups. Estimates of overweight and obesity combined ranged from 6.4% to 82.8%. Studies were heterogenous. Global distribution was skewed. Increasing adiposity was seen over time, in older adults and in women. Only six studies were at low risk of bias. Body mass index was the predominant measure used. There were no studies reporting cascade of care. No qualitative studies were identified. CONCLUSION Overweight and obesity varied in crisis affected populations but were rarely absent. Improved reporting of existing data could provide more accurate estimates. Worsening obesity may be prevented by acting earlier in long-term crises and targeting risk groups. The use of waist circumference would provide useful additional information. Gaps remain in understanding the existing cascade of care. Cultural norms around diet and ideal body size vary.
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Affiliation(s)
- Thomas Shortland
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Majel McGranahan
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Daniel Stewart
- National Public Health Specialty Training Programme, South West Training Scheme, Bristol, United Kingdom
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Saran Shantikumar
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - William Proto
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Bassit Malik
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Roger Yau
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Maddie Cobbin
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Gavin Rudge
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Farah Kidy
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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12
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Almeida PFD, Casotti E, Silvério RFL. Care trajectories of COVID-19 patients: from preventive measures to rehabilitation. CAD SAUDE PUBLICA 2023. [DOI: 10.1590/0102-311xen163222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
This study aims to analyze the care trajectories of patients diagnosed with COVID-19 who were hospitalized and are currently undergoing rehabilitation regarding their use of and access to the healthcare network (HN). An evaluative, qualitative study was carried out based on interviews with patients in the city of Niterói, Rio de Janeiro State, Brazil. The care trajectories were reconstructed at three different occasions that express their experiences with the healthcare and support network during the pandemic: prevention, support and diagnosis measures; hospitalization; post-COVID-19 care, rehabilitation and support. The results indicate that the main source of information about COVID-19 was TV newscasts. Preventive hygiene measures were the most widely adopted. The family was the main support network. There was no waiting time for admission to the municipal referral hospital. Hospitalization was very well evaluated in terms of user embracement, multidisciplinary care, virtual visits and daily contact between doctor and family members. A post-discharge “care vacuum” was identified, with no follow-up by primary health care (PHC) and other public services. Low-cost health insurance plans and private specialized post-COVID-19 services were frequently and spontaneously sought until the implementation of the rehabilitation service. In summary, solitary and discontinuous care trajectories of individuals and families shed light on several challenges to the health system, including guaranteed access to coordinated PHC and expanded offer of specialized public services and rehabilitation, aligned with the principles of humanized care, in addition to the maintenance of social support measures.
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Hamilton D, Sultana M, Ho LL, Arai M, Businge E, Lukwata R, Maina AGK, Khadka M, Wright J. Managing hypertension in a Rohingya refugee camp: a brief report. BMJ Open Qual 2022; 11:bmjoq-2022-001846. [PMID: 36588321 PMCID: PMC9743362 DOI: 10.1136/bmjoq-2022-001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Non-communicable diseases have overtaken communicable diseases as the most common cause of death worldwide, with the majority of these deaths in low-income and middle-income countries. Hypertension alone causes over nine million deaths per year.Since 2017, around 750 000 Rohingya refugees have fled violence in Myanmar into Cox's Bazar District in Bangladesh. We describe a quality improvement project focused on the management of hypertension in Rohingya refugees in three primary health facilities within the Rohingya refugee camps. The aim of the project was to create a sustainable hypertension service within existing primary care services.A number of plan-do-study-act cycles were performed to improve care, with methods including: creating a specialised clinic, writing a treatment algorithm, training of pharmacists, engaging community health workers and educational programmes for staff and patients.In 2020, 554 patients were engaged in the new hypertension service. Of these, 358 (64.6%) returned for follow-up at least once. Mean systolic blood pressure (BP) was 141.7 (SD 60.0) mm Hg and mean diastolic BP was 88.1 (SD 11.1) mm Hg. Patients engaged in treatment had a significant reduction of BP of 8.2 (95% CI 5.4 to 11.0)/6.0 (95% CI 4.1 to 7.9) mm Hg (p<0.0001).Our project shows that it is possible to create a hypertension service in a challenging humanitarian crisis, which can successfully improve the control of hypertension, although retention in care can be difficult.
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Affiliation(s)
- David Hamilton
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK,Medical Teams International, Cox's Bazar, Bangladesh
| | | | - Lee Lee Ho
- Medical Teams International, Cox's Bazar, Bangladesh
| | - Mikiko Arai
- Medical Teams International, Cox's Bazar, Bangladesh
| | | | | | | | - Mira Khadka
- United Nations High Commissioner for Refugees, Cox's Bazar, Bangladesh
| | - Joy Wright
- Medical Teams International, Cox's Bazar, Bangladesh
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Andrade EL, Cordova A, Schagen CRV, Jula M, Rodriguez-Diaz CE, Rivera MI, Santos-Burgoa C. The impact of Hurricane Maria on individuals living with non-communicable disease in Puerto Rico: the experience of 10 communities. BMC Public Health 2022; 22:2083. [PMCID: PMC9664670 DOI: 10.1186/s12889-022-14552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Coinciding with the rising non-communicable disease (NCD) prevalence worldwide is the increasing frequency and severity of natural hazards. Protecting populations with NCDs against natural hazards is ever more pressing given their increased risk of morbidity and mortality in disaster contexts. This investigation examined Hurricane Maria’s impacts across ten lower SES municipalities in Puerto Rico with varying community characteristics and hurricane impacts to understand experiences of supporting individuals with NCD management in the six-month period following the hurricane.
Methods
We conducted 40 qualitative interviews with mayors, first responders, faith leaders, community leaders, and municipal employees from 10 municipalities in Puerto Rico. Using QSR NVivo software, we deductively and inductively coded interview transcripts and undertook thematic analysis to characterize community-level hurricane impact and consequences for NCD management, and to identify convergent and divergent themes.
Results
Damages to infrastructure, including healthcare facilities and roadways, complicated the provision of timely health care for NCDs, patient transport, and pharmaceutical/medical supply chain continuity. Lengthy power outages at both healthcare facilities and private residences were barriers to healthcare service delivery, use of medical equipment, and storage of prescription medications with refrigeration, and led to a widespread mental health crisis. Cascading failures such as fuel shortages further compounded these challenges. The consequences of these impacts included the reported exacerbation of health conditions and loss of life among NCD patients.
Conclusions
Study findings identify contributors to morbidity and mortality among individuals with NCDs following Hurricane Maria. With the growing frequency of catastrophic disasters from natural hazards, the experiences of communities that endured these impacts offer important lessons regarding policies and practices to better support community disaster resilience and address the evolving preparedness needs of NCD patients.
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Kehlenbrink S, Ansbro É, Besançon S, Hassan S, Roberts B, Jobanputra K. Strengthening Diabetes Care in Humanitarian Crises in Low- and Middle-income Settings. J Clin Endocrinol Metab 2022; 107:e3553-e3561. [PMID: 35639997 DOI: 10.1210/clinem/dgac331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Indexed: 11/19/2022]
Abstract
Amid the growing global diabetes epidemic, the scale of forced displacement resulting from armed conflict and humanitarian crises is at record-high levels. More than 80% of the displaced population lives in lower- and middle-income countries, which also host 81% of the global population living with diabetes. Most crises are protracted, often lasting decades, and humanitarian aid organizations are providing long-term primary care to both the local and displaced populations. Humanitarian crises are extremely varied in nature and occur in contexts that are diverse and dynamic. The scope of providing diabetes care varies depending on the phase of the crisis. This paper describes key challenges and possible solutions to improving diabetes care in crisis settings. It focuses on (1) ensuring a reliable supply of life preserving medications and diagnostics, (2) restoring and maintaining access to health care, and (3) adapting service design to the context. These challenges are illustrated through case studies in Ukraine, Mali, the Central African Republic, and Jordan.
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Affiliation(s)
- Sylvia Kehlenbrink
- Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Humanitarian Initiative, Cambridge, MA 02138, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Éimhín Ansbro
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | | | - Saria Hassan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322,USA
- Emory Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
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Favas C, Ansbro É, Eweka E, Agarwal G, Lazo Porras M, Tsiligianni I, Vedanthan R, Webster R, Perel P, Murphy A. Factors Influencing the Implementation of Remote Delivery Strategies for Non-Communicable Disease Care in Low- and Middle-Income Countries: A Narrative Review. Public Health Rev 2022; 43:1604583. [PMID: 35832336 PMCID: PMC9272771 DOI: 10.3389/phrs.2022.1604583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives: The COVID-19 pandemic has disrupted health care for non-communicable diseases (NCDs) and necessitated strategies to minimize contact with facilities. We aimed to examine factors influencing implementation of remote (non-facility-based) delivery approaches for people with hypertension and/or diabetes in low- and middle-income countries (LMICs), to inform NCD care delivery during health service disruption, including humanitarian crises. Methods: Our narrative review used a hermeneutic and purposive approach, including primary studies conducted in LMICs, which assessed implementation factors influencing remote NCD care delivery. Results were analyzed using the Consolidated Framework for Implementation Research. Results: Twenty-eight included studies revealed the strong influence of both internal organizational and broader contextual factors, such as community health worker policies or technological environment. Addressing patients’ specific characteristics, needs and resources was important for implementation success. Conclusion: This review highlighted the multiple, complex, interdependent factors influencing implementation of remote NCD care in LMICs. Our findings may inform actors designing NCD care delivery in contexts where facility-based access is challenging. Implementation research is needed to evaluate context-adapted e-Health, community-based, and simplified clinical management strategies to facilitate remote NCD care.
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Affiliation(s)
- Caroline Favas
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Éimhín Ansbro
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Evette Eweka
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Maria Lazo Porras
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland.,CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Rethymno, Greece
| | - Rajesh Vedanthan
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Ruth Webster
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia.,George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Adrianna Murphy
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
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Harris P, Kirkland R, Masanja S, Le Feuvre P, Montgomery S, Ansbro É, Woodman M, Harris M. Strengthening the primary care workforce to deliver high-quality care for non-communicable diseases in refugee settings: lessons learnt from a UNHCR partnership. BMJ Glob Health 2022; 7:bmjgh-2021-007334. [PMID: 35798443 PMCID: PMC9272076 DOI: 10.1136/bmjgh-2021-007334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/27/2022] [Indexed: 12/21/2022] Open
Abstract
Non-communicable disease (NCD) prevention and care in humanitarian contexts has been a long-neglected issue. Healthcare systems in humanitarian settings have focused heavily on communicable diseases and immediate life-saving health needs. NCDs are a significant cause of morbidity and mortality in refugee settings, however, in many situations NCD care is not well integrated into primary healthcare services. Increased risk of poorer outcomes from COVID-19 for people living with NCDs has heightened the urgency of responding to NCDs and shone a spotlight on their relative neglect in these settings. Partnering with the United Nations Refugee Agency (UNHCR) since 2014, Primary Care International has provided clinical guidance and Training of Trainer (ToT) courses on NCDs to 649 health professionals working in primary care in refugee settings in 13 countries. Approximately 2300 healthcare workers (HCW) have been reached through cascade trainings over the last 6 years. Our experience has shown that, despite fragile health services, high staff turnover and competing clinical priorities, it is possible to improve NCD knowledge, skills and practice. ToT programmes are a feasible and practical format to deliver NCD training to mixed groups of HCW (doctors, nurses, technical officers, pharmacy technicians and community health workers). Clinical guidance must be adapted to local settings while co-creating an enabling environment for health workers is essential to deliver accessible, high-quality continuity of care for NCDs. On-going support for non-clinical systems change is equally critical for sustained impact. A shared responsibility for cascade training—and commitment from local health partners—is necessary to raise NCD awareness, influence local and national policy and to meet the UNHCR’s objective of facilitating access to integrated prevention and control of NCDs.
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Affiliation(s)
| | | | - Saimon Masanja
- School of Public Health, Catholic University of Health and Allied Sciences (CUHAS), Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Éimhín Ansbro
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael Woodman
- The Office of the United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Sayan M, Eren MF, Kilic SS, Kotek A, Kaplan SO, Duran O, Cukurcayır F, Babalıoglu I, Or OD, Ozturk GA, Eroglu C, Teke F, Kurtul N, Kutuk T, Bicakci BC, Senyurek S, Aktan M, Mamidanna S, Ohri N, Haffty B, Atalar B. Utilization of radiation therapy and predictors of noncompliance among Syrian refugees in Turkey. BMC Cancer 2022; 22:532. [PMID: 35550042 PMCID: PMC9097407 DOI: 10.1186/s12885-022-09558-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Access to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT. Methods In this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2019 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, sex, diagnosis, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined. Results We identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06–2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43–5.19, p < 0.001) were associated with noncompliance. Age, sex and treatment length were not significantly associated with noncompliance. Conclusions Noncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street. ASB1 - L2, Boston, MA, 02115, USA.
| | - Mehmet Fuat Eren
- Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | | | - Ayse Kotek
- Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | | | - Ozge Duran
- Sanliurfa Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | | | | | | | | | | | | | | | - Tugce Kutuk
- Malatya Education and Research Hospital, Malatya, Turkey
| | | | - Sukran Senyurek
- Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Turkey
| | | | - Swati Mamidanna
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nisha Ohri
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Bruce Haffty
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Ansbro É, Issa R, Willis R, Blanchet K, Perel P, Roberts B. Chronic NCD care in crises: a qualitative study of global experts’ perspectives on models of care for hypertension and diabetes in humanitarian settings. J Migr Health 2022; 5:100094. [PMID: 35434681 PMCID: PMC9010603 DOI: 10.1016/j.jmh.2022.100094] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 10/29/2022] Open
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Nola IA, Francula-Zaninovic S. Management of Cardiac Patients in Epidemic Outbreak. Curr Cardiol Rev 2022; 18:e120422203466. [PMID: 35418288 PMCID: PMC9893143 DOI: 10.2174/1573403x18666220412140105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 11/22/2022] Open
Abstract
In times of COVID-19 epidemic/pandemic, cardiac patients are vulnerable group with many specific conditions that could aggravate their condition. In this narrative review, we present possible measures adequate in managing cardiac patients in epidemic outbreak. An overview of the role of cardiologists and Crisis Management Team in management of cardiac patients is given. Protocols and measures implemented in COVID-19 crises are presented in light of risk assessment and disease prevention of cardiac patients and measures that should be taken for each cardiac condition. Specificity of epidemics calls for specific measures in addressing cardiac patients as part of the affected population. Many possible outcomes could be expected in an epidemic outbreak in relation to cardiovascular diseases, but tailored measures will keep cardiac patients safe. Proposed preventive measures for cardiac patients could be implemented in existing protocols for epidemic outbreak.
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Affiliation(s)
- Iskra Alexandra Nola
- University of Zagreb, School of Medicine, Andrija Stampar School of Public Health, Zagreb, Croatia
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21
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Ansbro É, Garry S, Karir V, Reddy A, Jobanputra K, Fardous T, Sadique Z. Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study. Health Policy Plan 2021; 35:931-940. [PMID: 32621490 PMCID: PMC8312704 DOI: 10.1093/heapol/czaa050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Syrian conflict has caused enormous displacement of a population with a high
non-communicable disease (NCD) burden into surrounding countries, overwhelming health
systems’ NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD
programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the
response. Cost data, which are currently lacking, may support programme adaptation and
system scale up of such NCD services. This descriptive costing study from the provider
perspective explored financial costs of the MSF NCD programme. We estimated annual total,
per patient and per consultation costs for 2015–17 using a combined ingredients-based and
step-down allocation approach. Data were collected via programme budgets, facility
records, direct observation and informal interviews. Scenario analyses explored the impact
of varying procurement processes, consultation frequency and task sharing. Total annual
programme cost ranged from 4 to 6 million International Dollars (INT$), increasing
annually from INT$4 206 481 (2015) to INT$6 739 438 (2017), with costs driven mainly by
human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to
1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209
to 253 (2015–17). Annual cost increases reflected growing patient load and increasing
service complexity throughout 2015–17. A scenario importing all medications cut total
costs by 31%, while negotiating importation of high-cost items offered 13% savings.
Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more
sensitive to reducing clinical review frequency than to task sharing review to nurses.
Over 1000 extra patients could be enrolled without additional staffing cost if care
delivery was restructured. Total costs significantly exceeded costs reported for NCD care
in low-income humanitarian contexts. Efficiencies gained by revising procurement and/or
restructuring consultation models could confer cost savings or facilitate cohort
expansion. Cost effectiveness studies of adapted models are recommended.
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Affiliation(s)
- Éimhín Ansbro
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Sylvia Garry
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Veena Karir
- Médecins sans Frontières, Plantage Middenlaan 14 1018 DD Amsterdam, The Netherlands
| | - Amulya Reddy
- Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB, UK
| | - Kiran Jobanputra
- Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB, UK
| | - Taissir Fardous
- Health Economy Directorate, Ministry of Health, Pr. Hamzah St., Amman, Jordan
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Devi R, Goodyear-Smith F, Subramaniam K, McCormack J, Calder A, Parag V, Bizri LE, Majumdar A, Huang PH, Bullen C. The Impact of COVID-19 on the Care of Patients With Noncommunicable Diseases in Low- and Middle-Income Countries: An Online Survey of Patient Perspectives. J Patient Exp 2021; 8:23743735211034091. [PMID: 34368433 PMCID: PMC8317232 DOI: 10.1177/23743735211034091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We sought to gain insights into the impacts of COVID-19 and associated control measures on health and health care of patients from low- and middle-income countries with cardiovascular disease, diabetes, and mental health conditions, using an online survey during the COVID-19 pandemic. The most common concern for the 1487 patients who took part was contracting COVID-19 when they accessed health care. Of those infected with COVID-19, half said that their health had been worse since being infected. Collectively, most people reported an increase in feelings of stress and loneliness. The COVID-19 pandemic has led to a range of health care impacts on patients with noncommunicable diseases, including constraints on access to care and health effects, particularly mental well-being.
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Affiliation(s)
- Ratna Devi
- International Alliance of Patient Organizations, IAPO, London, United Kingdom
| | - Felicity Goodyear-Smith
- General Practice and Primary Healthcare, School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Jessica McCormack
- National Institute for Health Innovation, University of Auckland, Auckland New Zealand
| | - Amanda Calder
- National Institute for Health Innovation, University of Auckland, Auckland New Zealand
| | - Varsha Parag
- National Institute for Health Innovation, University of Auckland, Auckland New Zealand
| | - Luna El Bizri
- School of Pharmacy, Lebanese University, Hadath, Lebanon
| | | | | | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland New Zealand
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Sibai AM, Najem Kteily M, Barazi R, Chartouni M, Ghanem M, Afifi RA. Lessons learned in the provision NCD primary care to Syrian refugee and host communities in Lebanon: the need to 'act locally and think globally'. J Public Health (Oxf) 2021; 42:e361-e368. [PMID: 31763670 DOI: 10.1093/pubmed/fdz096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/15/2019] [Accepted: 07/21/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prevention and control of non-communicable diseases (NCDs) remain inadequate in resource-scarce countries, particularly in conflict situations. This paper describes a multicomponent intervention for management of hypertension and diabetes among older adult Syrian refugees and the Lebanese host community and reflects on challenges for scaling up NCD integration into primary care in humanitarian situations. METHODS Using a mixed method approach, the study focused on monitoring and evaluation of the three components of the intervention: healthcare physical facilities and documentation processes, provider knowledge and guideline-concordant performance, and refugee and host community awareness. RESULTS Findings revealed overall high compliance of healthcare workers with completing data collection forms. Their knowledge of basic aspects of hypertension/diabetes management was adequate, but diagnosis knowledge was low. Patients and healthcare providers voiced satisfaction with the program. Yet, interruptions in medicines' supplies and lapses in care were perceived by all study groups alike as the most problematic aspect of the program. CONCLUSIONS Our intervention program was aligned with internationally agreed-upon practices, yet, our experiences in the field point to the need for more 'local testing' of modified interventions within such contexts. This can then inform 'thinking globally' on guidelines for the delivery of NCD care in crisis settings.
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Affiliation(s)
- Abla M Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Martine Najem Kteily
- Center for Public Health Practice, Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Rana Barazi
- Center for Public Health Practice, Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Mia Chartouni
- Center for Public Health Practice, Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Maguy Ghanem
- HelpAge International, Lebanon Office, Beirut 1107 2020, Lebanon
| | - Rima A Afifi
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
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Keasley J, Oyebode O, Shantikumar S, Proto W, McGranahan M, Sabouni A, Kidy F. A systematic review of the burden of hypertension, access to services and patient views of hypertension in humanitarian crisis settings. BMJ Glob Health 2021; 5:bmjgh-2020-002440. [PMID: 33168520 PMCID: PMC7654140 DOI: 10.1136/bmjgh-2020-002440] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Globally, a record number of people are affected by humanitarian crises caused by conflict and natural disasters. Many such populations live in settings where epidemiological transition is underway. Following the United Nations high level meeting on non-communicable diseases, the global commitment to Universal Health Coverage and needs expressed by humanitarian agencies, there is increasing effort to develop guidelines for the management of hypertension in humanitarian settings. The objective was to investigate the prevalence and incidence of hypertension in populations directly affected by humanitarian crises; the cascade of care in these populations and patient knowledge of and attitude to hypertension. METHODS A literature search was carried out in five databases. Grey literature was searched. The population of interest was adult, non-pregnant, civilians living in any country who were directly exposed to a crisis since 1999. Eligibility assessment, data extraction and quality appraisal were carried out in duplicate. RESULTS Sixty-one studies were included in the narrative synthesis. They reported on a range of crises including the wars in Syria and Iraq, the Great East Japan Earthquake, Hurricane Katrina and Palestinian refugees. There were few studies from Africa or Asia (excluding Japan). The studies predominantly assessed prevalence of hypertension. This varied with geography and age of the population. Access to care, patient understanding and patient views on hypertension were poorly examined. Most of the studies had a high risk of bias due to methods used in the diagnosis of hypertension and in the selection of study populations. CONCLUSION Hypertension is seen in a range of humanitarian settings and the burden can be considerable. Further studies are needed to accurately estimate prevalence of hypertension in crisis-affected populations throughout the world. An appreciation of patient knowledge and understanding of hypertension as well as the cascade of care would be invaluable in informing service provision.
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Affiliation(s)
- James Keasley
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - William Proto
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Amar Sabouni
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Farah Kidy
- Warwick Medical School, University of Warwick, Coventry, UK
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Shah S, Munyuzangabo M, Gaffey MF, Kamali M, Jain RP, Als D, Meteke S, Radhakrishnan A, Siddiqui FJ, Ataullahjan A, Bhutta ZA. Delivering non-communicable disease interventions to women and children in conflict settings: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2019-002047. [PMID: 32341086 PMCID: PMC7202786 DOI: 10.1136/bmjgh-2019-002047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/25/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death worldwide. In the context of conflict settings, population displacement, disrupted treatment, infrastructure damage and other factors impose serious NCD intervention delivery challenges, but relatively little attention has been paid to addressing these challenges. Here we synthesise the available indexed and grey literature reporting on the delivery of NCD interventions to conflict-affected women and children in low- and middle-income countries (LMICs). Methods A systematic search in MEDLINE, Embase, CINAHL and PsycINFO databases for indexed articles published between 1 January 1990 and 31 March 2018 was conducted, and publications reporting on NCD intervention delivery to conflict-affected women or children in LMICs were included. A grey literature search of 10 major humanitarian organisation websites for publications dated between 1 January 2013 and 30 November 2018 was also conducted. We extracted and synthesised information on intervention delivery characteristics and delivery barriers and facilitators. Results Of 27 included publications, most reported on observational research studies, half reported on studies in the Middle East and North Africa region and 80% reported on interventions targeted to refugees. Screening and medication for cardiovascular disease and diabetes were the most commonly reported interventions, with most publications reporting facility-based delivery and very few reporting outreach or community approaches. Doctors were the most frequently reported delivery personnel. No publications reported on intervention coverage or on the effectiveness of interventions among women or children. Limited population access and logistical constraints were key delivery barriers reported, while innovative technology use, training of workforce and multidisciplinary care were reported to have facilitated NCD intervention delivery. Conclusion Large and persistent gaps in information and evidence make it difficult to recommend effective strategies for improving the reach of quality NCD care among conflict-affected women and children. More rigorous research and reporting on effective strategies for delivering NCD care in conflict contexts is urgently needed. PROSPERO registration number CRD42019125221
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Affiliation(s)
- Shailja Shah
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mariella Munyuzangabo
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Meteke
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada .,Center of Excellence in Women and Children Health, Aga Khan University, Karachi, Pakistan
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The impact of COVID-19 on the care of people living with noncommunicable diseases in low- and middle-income countries: an online survey of physicians and pharmacists in nine countries. Prim Health Care Res Dev 2021; 22:e30. [PMID: 34120672 PMCID: PMC8220477 DOI: 10.1017/s146342362100030x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The global COVID-19 pandemic has disrupted healthcare worldwide. In low- and middle-income countries (LMICs), where people may have limited access to affordable quality care, the COVID-19 pandemic has the potential to have a particularly adverse impact on the health and healthcare of individuals with noncommunicable diseases (NCDs). A World Health Organization survey found that disruption of delivery of healthcare for NCDs was more significant in LMICs than in high-income countries. However, the study did not elicit insights into the day-to-day impacts of COVID-19 on healthcare by front-line healthcare workers (FLHCWs). AIM To gain insights directly from FLHCWs working in countries with a high NCD burden, and thereby identify opportunities to improve the provision of healthcare during the current pandemic and in future healthcare emergencies. METHODS We recruited selected frontline healthcare workers (general practitioners, pharmacists, and other medical specialists) from nine countries to complete an online survey (n = 1347). Survey questions focused on the impact of COVID-19 pandemic on clinical practice and NCDs; barriers to clinical care during the pandemic; and innovative responses to the many challenges presented by the pandemic. FINDINGS The majority of FLHCWs responding to our survey reported that their care of patients had been impacted both adversely and positively by the public health measures imposed. Most FLHCs (95%) reported a deterioration in the mental health of their patients. CONCLUSIONS Continuity of care for NCDs as part of pandemic preparedness is needed so that chronic conditions are not exacerbated by public health measures and the direct impacts of the pandemic.
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Haderer F, Venables E, van Olmen J, Orcutt M, Ghassibe-Sabbagh M, van den Boogaard W. "I try the one that they say is good." - factors influencing choice of health care provider and pathways to diabetes care for Syrian refugees in Lebanon. Confl Health 2021; 15:45. [PMID: 34090503 PMCID: PMC8178894 DOI: 10.1186/s13031-021-00375-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
Background Navigating health systems in host countries can be a challenge for refugees, particularly in a multi-provider system such as Lebanon. Syrian refugees in Lebanon face a high burden of Non-Communicable Diseases (NCDs) including diabetes mellitus. Evidence on how refugees navigate the health system is essential to improve provision of NCD services. We conducted a qualitative study amongst Syrian diabetes patients visiting Médecins Sans Frontières (MSF) clinics in one urban and one rural setting in Lebanon to explore factors influencing choice of and pathways to diabetes care. Methods In-depth interviews were conducted with male and female adult participants with DM type 1 or type 2 who were receiving treatment at MSF clinics. Participants were recruited using convenience sampling. Interviews were conducted in Arabic and directly transcribed and translated into English. Data were coded in NVivo and analyzed using an inductive thematic approach. Results A total of 29 in-depth interviews were conducted with 13 men and 16 women. Knowledge and understanding of diabetes management differed among participants. Syrian refugees in Lebanon gathered information about health services for diabetes largely from social networks of family and peers rather than through formal means. Pathways to care included different combinations of providers such as clinics, pharmacists and informal providers. Conclusions Syrian refugees with diabetes in Lebanon face considerable challenges in navigating the health care system due to their vulnerable status and limited knowledge of the host country systems. To ensure access to care for diabetes, efforts need to be made to support patients’ orientation in the Lebanese health system.
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Affiliation(s)
- Flora Haderer
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium. .,Institute of Tropical Medicine, Antwerp, Belgium.
| | - Emilie Venables
- Médecins Sans Frontières Operational Centre Brussels, Luxembourg Operational Research Unit (LuxOR), Luxembourg, Luxembourg.,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Josefien van Olmen
- Institute of Tropical Medicine, Antwerp, Belgium.,Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Miriam Orcutt
- Migration Health Specialist, Forced Migration Team, Analysis Department, Médecins Sans Frontières Operational Centre Belgium, Brussels, Belgium.,Present address: Institute for Global Health, University College London, London, United Kingdom
| | | | - Wilma van den Boogaard
- Médecins Sans Frontières Operational Centre Brussels, Brussels, Belgium.,Médecins Sans Frontières Operational Centre Brussels, Luxembourg Operational Research Unit (LuxOR), Luxembourg, Luxembourg
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28
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Ghazanchaei E, Khorasani-Zavareh D, Aghazadeh-Attari J, Mohebbi I. Identifying and Describing Impact of Disasters on Non-Communicable Diseases: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1143-1155. [PMID: 34540735 PMCID: PMC8410956 DOI: 10.18502/ijph.v50i6.6413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with non-communicable diseases are vulnerable to disasters. This is a systematic review describing the impact of disasters on non-communicable diseases. METHODS A systematic review was conducted using PRISMA standards. Relevant articles published from 1997 to 2019 collected by searching the Scopus, PubMed, Science Direct, databases. We specifically examined reports describing NCDs and including the key words "non-communicable disease and Disasters". NCDs included cardiovascular, respiratory, diabetes, cancer and mental health diseases. RESULTS Of the 663 studies identified, only 48 articles met all the eligibility criteria. Most studies have shown the impact of all natural disasters on non-communicable diseases (39.8% n=19). The largest study was the effect of earthquakes on non-communicable diseases (29.2% n=14). For the NCDs targeted by this research, most of the included studies were a combination of four diseases: cardiovascular disease, respiratory disease, diabetes and cancer (44% n=21). Followed by cardiovascular disease (14.6% n=7), chronic respiratory disease (12.5% n=6), diabetes and cancer (6.2% n=3) and mental health (12.5% n=6). CONCLUSION The incidence of disasters affects the management of treatment and care for patients with NCDs. Specific measures include a multi-part approach to ensuring that patients with non-communicable diseases have access to life-saving services during and after disasters. The approach of the health system should be expanded from traditional approaches to disasters and requires comprehensive planning of health care by policy makers and health professionals to develop effective strategies to enable patients to access medical, therapeutic and diagnostic services in natural disasters.
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Affiliation(s)
- Elham Ghazanchaei
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Davoud Khorasani-Zavareh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Workplace Health Promotion Research Center, Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javad Aghazadeh-Attari
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Iraj Mohebbi
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
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Nassereddine G, Habli S, Slama S, Sen K, Rizk A, Sibai AM. COVID-19 and non-communicable diseases in the Eastern Mediterranean Region: the need for a syndemics approach to data reporting and healthcare delivery. BMJ Glob Health 2021; 6:e006189. [PMID: 34103327 PMCID: PMC8188577 DOI: 10.1136/bmjgh-2021-006189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/18/2021] [Indexed: 01/22/2023] Open
Affiliation(s)
- Ghiwa Nassereddine
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Samia Habli
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Slim Slama
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Kasturi Sen
- Wolfson College (CR), University of Oxford, Oxford, UK
| | - Anthony Rizk
- Department of Anthropology and Sociology, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Abla M Sibai
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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30
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Papautsky EL, Rice DR, Ghoneima H, McKowen ALW, Anderson N, Wootton AR, Veldhuis C. Characterizing Health Care Delays and Interruptions in the United States During the COVID-19 Pandemic: Internet-Based, Cross-sectional Survey Study. J Med Internet Res 2021; 23:e25446. [PMID: 33886489 PMCID: PMC8136407 DOI: 10.2196/25446] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/16/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background The COVID-19 pandemic has broader geographic spread and potentially longer lasting effects than those of previous disasters. Necessary preventive precautions for the transmission of COVID-19 has resulted in delays for in-person health care services, especially at the outset of the pandemic. Objective Among a US sample, we examined the rates of delays (defined as cancellations and postponements) in health care at the outset of the pandemic and characterized the reasons for such delays. Methods As part of an internet-based survey that was distributed on social media in April 2020, we asked a US–based convenience sample of 2570 participants about delays in their health care resulting from the COVID-19 pandemic. Participant demographics and self-reported worries about general health and the COVID-19 pandemic were explored as potent determinants of health care delays. In addition to all delays, we focused on the following three main types of delays, which were the primary outcomes in this study: dental, preventive, and diagnostic care delays. For each outcome, we used bivariate statistical tests (t tests and chi-square tests) and multiple logistic regression models to determine which factors were associated with health care delays. Results The top reported barrier to receiving health care was the fear of SARS-CoV-2 infection (126/374, 33.6%). Almost half (1227/2570, 47.7%) of the participants reported experiencing health care delays. Among those who experienced health care delays and further clarified the type of delay they experienced (921/1227, 75.1%), the top three reported types of care that were affected by delays included dental (351/921, 38.1%), preventive (269/921, 29.2%), and diagnostic (151/921, 16.4%) care. The logistic regression models showed that age (P<.001), gender identity (P<.001), education (P=.007), and self-reported worry about general health (P<.001) were significantly associated with experiencing health care delays. Self-reported worry about general health was negatively related to experiencing delays in dental care. However, this predictor was positively associated with delays in diagnostic testing based on the logistic regression model. Additionally, age was positively associated with delays in diagnostic testing. No factors remained significant in the multiple logistic regression for delays in preventive care, and although there was trend between race and delays (people of color experienced fewer delays than White participants), it was not significant (P=.06). Conclusions The lessons learned from the initial surge of COVID-19 cases can inform systemic mitigation strategies for potential future disruptions. This study addresses the demand side of health care delays by exploring the determinants of such delays. More research on health care delays during the pandemic is needed, including research on their short- and long-term impacts on patient-level outcomes such as mortality, morbidity, mental health, people’s quality of life, and the experience of pain.
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Affiliation(s)
- Elizabeth Lerner Papautsky
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Dylan R Rice
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Hana Ghoneima
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Anna Laura W McKowen
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Nicholas Anderson
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Angie R Wootton
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States
| | - Cindy Veldhuis
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
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31
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Jaung MS, Willis R, Sharma P, Aebischer Perone S, Frederiksen S, Truppa C, Roberts B, Perel P, Blanchet K, Ansbro É. Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review. Health Policy Plan 2021; 36:509-532. [PMID: 33693657 PMCID: PMC8128021 DOI: 10.1093/heapol/czab007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/02/2023] Open
Abstract
Care for non-communicable diseases, including hypertension and diabetes (HTN/DM), is recognized as a growing challenge in humanitarian crises, particularly in low- and middle-income countries (LMICs) where most crises occur. There is little evidence to support humanitarian actors and governments in designing efficient, effective, and context-adapted models of care for HTN/DM in such settings. This article aimed to systematically review the evidence on models of care targeting people with HTN/DM affected by humanitarian crises in LMICs. A search of the MEDLINE, Embase, Global Health, Global Indexus Medicus, Web of Science, and EconLit bibliographic databases and grey literature sources was performed. Studies were selected that described models of care for HTN/DM in humanitarian crises in LMICs. We descriptively analysed and compared models of care using a conceptual framework and evaluated study quality using the Mixed Methods Appraisal Tool. We report our findings according to PRISMA guidelines. The search yielded 10 645 citations, of which 45 were eligible for this review. Quantitative methods were most commonly used (n = 34), with four qualitative, three mixed methods, and four descriptive reviews of specific care models were also included. Most studies detailed primary care facility-based services for HTN/DM, focusing on health system inputs. More limited references were made to community-based services. Health care workforce and treatment protocols were commonly described framework components, whereas few studies described patient centredness, quality of care, financing and governance, broader health policy, and sociocultural contexts. There were few programme evaluations or effectiveness studies, and only one study reported costs. Most studies were of low quality. We concluded that an increasing body of literature describing models of care for patients with HTN/DM in humanitarian crises demonstrated the development of context-adapted services but showed little evidence of impact. Our conceptual framework could be used for further research and development of NCD models of care.
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Affiliation(s)
- Michael S Jaung
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Department of Emergency Medicine, Baylor College of Medicine, 1504 Ben Taub Loop, Houston, 77030, TX, USA
| | - Ruth Willis
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Piyu Sharma
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sigiriya Aebischer Perone
- Health Unit, international Committee of the Red Cross, Avenue de la Paix 19, 1202 Geneva, Switzerland
| | | | - Claudia Truppa
- Health Unit, international Committee of the Red Cross, Avenue de la Paix 19, 1202 Geneva, Switzerland
| | - Bayard Roberts
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology and Centre for Global Chronic Conditions, Faculty of Epidemiology and Population Health, Keppel Street, London WC1E 7HT, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, 24 rue du Général-Dufour, Geneva, Switzerland
| | - Éimhín Ansbro
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Parmar PK, Rawashdah F, Al-Ali N, Abu Al Rub R, Fawad M, Al Amire K, Al-Maaitah R, Ratnayake R. Integrating community health volunteers into non-communicable disease management among Syrian refugees in Jordan: a causal loop analysis. BMJ Open 2021; 11:e045455. [PMID: 33879489 PMCID: PMC8061821 DOI: 10.1136/bmjopen-2020-045455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Globally, there is emerging evidence on the use of community health workers and volunteers in low-income and middle-income settings for the management of non-communicable diseases (NCDs), provision of out-of-clinic screening, linkage with health services, promotion of adherence, and counselling on lifestyle and dietary changes. Little guidance exists on the role of this workforce in supporting NCD care for refugees who lack access to continuous care in their host country. The goals of this work were to evaluate the current roles of community health volunteers (CHVs) in the management of diabetes and hypertension (HTN) among Syrian refugees and to suggest improvements to the current primary care model using community health strategies. SETTING AND PARTICIPANTS A participatory, multistakeholder causal loop analysis workshop with representatives from the Ministry of Health of Jordan, non-governmental organisations, United Nations agencies, CHVs and refugee patients was conducted in June 2019 in Amman, Jordan. PRIMARY OUTCOME This causal loop analysis workshop was used to collaboratively develop a causal loop diagram and CHV strategies designed to improve the health of Syrian refugees with diabetes and HTN living in Jordan. RESULTS During the causal loop analysis workshop, participants collaboratively identified and mapped how CHVs might improve care among diagnosed patients. Possibilities identified included the following: providing psychosocial support and foundational education on their conditions, strengthening self-management of complications (eg, foot checks), and monitoring patients for adherence to medications and collection of basic health monitoring data. Elderly refugees with restricted mobility and/or uncontrolled disease were identified as a key population where CHVs could provide home-based blood glucose and blood pressure measurement and targeted health education to provide more precise monitoring. CONCLUSIONS CHV programmes were cited as a key strategy to implement secondary prevention of morbidity and mortality among Syrian refugees, particularly those at high risk of decompensation.
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Affiliation(s)
- Parveen K Parmar
- Department of Emergency Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Nahla Al-Ali
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Raeda Abu Al Rub
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Rowaida Al-Maaitah
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ruwan Ratnayake
- International Rescue Committee, New York, New York, USA
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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A Validation Study of the Rainbow Model of Integrated Care-Measurement Tool for Patients in China. Int J Integr Care 2021; 21:5. [PMID: 33976595 PMCID: PMC8064292 DOI: 10.5334/ijic.5603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. The aim of this paper is to modify the original patient version of the RMIC-MT for the Chinese primary care context and validate its psychometric properties. Methods: The translation and adaptation processes were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a cross-sectional study with 386 patients with diabetes attending one of 20 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method was used to assess the construct validity. Confirmation factor analysis was used to evaluate model fit of the modified version. Cronbach’s alpha was used to ascertain the internal consistency reliability. Results: During the translation and adaptation process, all 24 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Five factors (person-centeredness, clinical integration, professional integration, team-based coordination, organizational integration) with 15 items were determined by exploratory factor analysis, accounting for 53.51% of the total variance. Good internal consistency was achieved with each item correlated the highest on an assigned subscale and Cronbach’s alpha score of 0.890. Moderately positive associations (r≥ 0.4, p<0.01) between the score of the scale and these correlations indicate good construct validity. Conclusions: The results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT patient version. Its application in China will promote the development of people-centered integrated primary care. However, future studies with diverse samples crossing regions would be needed to test its psychometric properties for the various Chinese primary care contexts.
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Li Z, Jiang Y, Yu Y, Kang Q. Effect of COVID-19 Pandemic on Diagnosis and Treatment Delays in Urological Disease: Single-Institution Experience. Risk Manag Healthc Policy 2021; 14:895-900. [PMID: 33692641 PMCID: PMC7939494 DOI: 10.2147/rmhp.s299233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/17/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose In the background of the global pandemic, we aim to investigate the effect of COVID-19 on diagnosis and treatment delay in urology patients. Patients and Methods A total of 4919 inpatients were identified from the urological department in our institution, including 2947 and 1972 patients within 9 months before and after the outbreak (group A and group B). The baseline characteristics and residential population of different types of diseases were compared in the two groups. Patients who underwent delay of diagnosis or treatment with poor outcomes were described. Results Our result revealed a 33.1% decrease of total resident population as well as a 44.8% decline in bed utilization rate after the outbreak. Significant differences were found between group A and group B in gender (P=0.024) and patients living alone or not (P=0.026). The hospitalization rate of patients with malignancy increased significantly while that of benign patients decreased during the epidemic (P<0.001). Besides, we identified 5 cases with bladder cancer and 3 cases with prostate cancer that underwent delay of diagnosis or treatment with unfavorable consequences. Conclusion With the impact of COVID-19, delay in diagnosis or treatment of non-COVID-19 diseases is inevitable whether the medical resources allocation is effective or not. Psychological status of patients might be the major cause of postponing diagnosis or treatment. For urological patients with locally advanced tumor or rapid progression, who need long-term postoperative intervention, the delay of regular treatment could lead to inevitable progression or recurrence.
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Affiliation(s)
- Zhen Li
- Department of Urology, The Fifth People's Hospital of Dalian, Dalian, Liaoning, People's Republic of China
| | - Yu Jiang
- Department of Pediatrics, Dalian Municipal Women and Children's Medical Center, Dalian, Liaoning, People's Republic of China
| | - Yang Yu
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Qianyu Kang
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
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Bausch FJ, Beran D, Hering H, Boulle P, Chappuis F, Dromer C, Saaristo P, Perone SA. Operational considerations for the management of non-communicable diseases in humanitarian emergencies. Confl Health 2021; 15:9. [PMID: 33632275 PMCID: PMC7905755 DOI: 10.1186/s13031-021-00345-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
Non-communicable diseases (NCD) represent an increasing global challenge with the majority of mortality occurring in low- and middle-income countries (LMICs). Concurrently, many humanitarian crises occur in these countries and the number of displaced persons, either refugees or internally displaced, has reached the highest level in history. Until recently NCDs in humanitarian contexts were a neglected issue, but this is changing. Humanitarian actors are now increasingly integrating NCD care in their activities and recognizing the need to harmonize and enhance NCD management in humanitarian crises. However, there is a lack of a standardized response during operations as well as a lack of evidence-based NCD management guidelines in humanitarian settings. An informal working group on NCDs in humanitarian settings, formed by members of the World Health Organization, Médecins Sans Frontières, the International Committee of the Red Cross, the International Federation of the Red Cross and others, and led by the United Nations High Commissioner for Refugees, teamed up with the University of Geneva and Geneva University Hospitals to develop operational considerations for NCDs in humanitarian settings. This paper presents these considerations, aiming at ensuring appropriate planning, management and care for NCD-affected persons during the different stages of humanitarian emergencies. Key components include access to treatment, continuity of care including referral pathways, therapeutic patient education/patient self-management, community engagement and health promotion. In order to implement these components, a standardized approach will support a consistent response, and should be based on an ethical foundation to ensure that the "do no harm" principle is upheld. Advocacy supported by evidence is important to generate visibility and resource allocation for NCDs. Only a collaborative approach of all actors involved in NCD management will allow the spectrum of needs and continuum of care for persons affected by NCDs to be properly addressed in humanitarian programmes.
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Affiliation(s)
- F. Jacquerioz Bausch
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Michel-Servet 1, 1206 Geneva, Switzerland
| | - D. Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Michel-Servet 1, 1206 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland
| | - H. Hering
- United Nations High Commissioner for Refugees, Rue de Montbrillant 94, 1202 Geneva, Switzerland
| | - P. Boulle
- Médecins Sans Frontières, Rue de Lausanne 78, 1202 Geneva, Switzerland
| | - F. Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Michel-Servet 1, 1206 Geneva, Switzerland
| | - C. Dromer
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
| | - P. Saaristo
- International Federation of the Red Cross, Chemin des Crêts 17, 1209 Geneva, Switzerland
| | - S. Aebischer Perone
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Michel-Servet 1, 1206 Geneva, Switzerland
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
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Establishing the Status of Patients With Non-Communicable Diseases in Disaster: A Systematic Review. Disaster Med Public Health Prep 2021; 16:783-790. [PMID: 33583461 DOI: 10.1017/dmp.2020.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE People with NCDs are particularly vulnerable to disasters. This research systematically reviewed reports describing studies on the status of patients with NCDs before, during and after disasters. METHOD Relevant articles published from 1997 to 2019 were collected by searching the Scopus, PubMed, and Science Direct databases. We specifically examined reports describing NCDs and including the key words 'Non-Communicable Disease and Disasters.' NCDs include cardiovascular, respiratory, diabetes and cancer diseases. RESULTS The review identified 42 relevant articles. Most of the included studies were found to have described the conditions of patients with NCDs after disasters - 14 (13.3%), during disasters - 11 (26.2%), before disasters - 6 (14.3%), within all stages of disasters: before, during and after - 6 (14.3%), only during and after disasters - 4 (9.5%), and includes before and during disasters - 1 (2.4%). CONCLUSION NCDs pose major health issues in disasters. Development of strong counter measures against the interruption of treatment, as well as surveillance systems to ascertain medical needs for NCDs are necessary as preparation for future disasters.
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Provision of the Continuum of Care to Noncommunicable Diseases Post-Floods in Kerala, India 2018. Disaster Med Public Health Prep 2021; 16:825-828. [PMID: 33563351 DOI: 10.1017/dmp.2020.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Integrating noncommunicable disease (NCD) in health care delivery during emergency response posed a major challenge post-floods in Kerala. Kerala experienced an abnormally high rainfall during mid-2018 where more than 400 people lost their lives. State health officials and the Disaster Response Team were sensitized about the importance of including NCDs in the response action. More than 80% of patients with hypertension and diabetes were not under control in Kerala. Under the state NCD cell, an NCD expert group was consulted for drafting the treatment and referral strategies. Steps to tackle NCDs during the disaster response were formulated. The state NCD cell decided to integrate NCDs in the response measures. The technical guidance document by the World Health Organization South-East Asia Region was consulted to formulate actions. The activities were implemented in 6 steps: prioritizing of major NCDS, patient estimation and drug stock preparation, standard treatment protocol, mapping of referral facilities, public engagement, and daily reporting of NCD consultations. Prioritizing the continuum of care of NCDs during floods among the program managers and care providers was crucial. The health education and communication campaign was done to sensitize the known NCD patients to seek early care. Daily reporting of consultations was established.
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Ghazanchaei E, Mohebbi I, Nouri F, Aghazadeh-Attari J, Khorasani-Zavareh D. Non-communicable diseases in disasters: a protocol for a systematic review. J Inj Violence Res 2021; 13:61-68. [PMID: 33459280 PMCID: PMC8142338 DOI: 10.5249/jivr.v13i1.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 12/19/2020] [Indexed: 12/05/2022] Open
Abstract
Background: NCDs require an ongoing management for optimal outcomes, which is challenging in emergency settings, because natural disasters increase the risk of acute NCD exacerbations and lead to health systems’ inability to respond. This study aims to develop a protocol for a systematic review on non-communicable diseases in natural disaster settings. Methods: This systematic review protocol is submitted to the International Prospective Register of Systematic Reviews (Registration No. CRD42020164032). The electronic databases to be used in this study include: Medline, Scopus, Web of Science, Clinical Key, CINAHL, EBSCO, Ovid, EMBASE, ProQuest, Google Scholar, Cochrane Library (Cochrane database of systematic reviews; Cochrane central Register of controlled Trials). Records from 1997 to 2019 are subject to this investigation. Three independent researchers will review the titles, abstracts, and full texts of articles eligible for inclusion, and if not matched, they will be reviewed by a final fourth reviewer. The proposed systematic review will be reported in accordance with the reporting guideline provided in the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. We select studies based on: PICOs (Participants, Interventions, Comparators, and Outcomes). Results: This systematic review identifies any impacts of natural disasters on patients with NCDs in three stages i.e. before, during and in the aftermath of natural disasters. Conclusions: A comprehensive response to NCD management in natural disasters is an important but neglected aspect of non-communicable disease control and humanitarian response, which can significantly reduce the potential risk of morbidity and mortality associated with natural disasters.
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Affiliation(s)
- Elham Ghazanchaei
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Iraj Mohebbi
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Fatemeh Nouri
- Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javad Aghazadeh-Attari
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Davoud Khorasani-Zavareh
- Workplace Health Promotion Research Center, Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Powell TM, Li SJ, Hsiao Y, Thompson M, Farraj A, Abdoh M, Farraj R. An integrated physical and mental health awareness education intervention to reduce non-communicable diseases among Syrian refugees and Jordanians in host communities: A natural experiment study. Prev Med Rep 2021; 21:101310. [PMID: 33532176 PMCID: PMC7823201 DOI: 10.1016/j.pmedr.2021.101310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/11/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022] Open
Abstract
The Syrian crisis has had a devastating impact on displaced populations and among host communities in neighboring countries such as Jordan. Many of these individuals are at risk for non-communicable diseases (NCD) and mental health disorders, yet do not have access to services designed to manage or prevent these conditions. The purpose of this study was to examine the efficacy of a non-communicable disease (NCD) awareness educational intervention and an integrated NCD and mental health education intervention on reducing cardiovascular disease (CVD) risk among Jordanians and displaced Syrians. This natural experiment study was conducted in three health centers in Irbid, Jordan with 213 Syrian participants and 382 Jordanians. Participants were assigned to one of three study conditions: the Healthy Community Clinic (HCC), a non-communicable disease educational intervention; the HCC with added mental health awareness sessions; standard healthcare. CVD risk factors were assessed at baseline, 12 and 18 months. The HCC education group yielded significant improvements in three CVD risk factors including: body mass index (BMI) -1.91 (95% CI: -2.09, -1.73); systolic blood pressure (SBP) -12.80 mmHg (95% CI: -16.35, -9.25); and diastolic blood pressure (DBP) -5.78 mmHg (95% CI: -7.96, -3.60) compared to standard care. The HCC-mental health treatment arm also demonstrated significant improvements in BMI, SBP, and DBP compared to standard care. Significant improvements in fasting blood glucose -20.32 (CI: -28.87, -11.77) and HbA1c -0.43 (-0.62, -0.24) were also illustrated in the HCC-mental health treatment arm. The HCC-mental health group sustained greater reductions in CVD risk than the HCC education group at 18-months. This study is among the first to our knowledge illustrating an integrated health and mental health educational intervention can reduce CVD risk among Syrian refugees and Jordanians. Continued investment and research in CVD prevention interventions is needed to enhance health, reduce costs, and have lasting benefits for conflict-affected individuals and communities.
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Affiliation(s)
- Tara M Powell
- University of Illinois, School of Social Work 1010 West Nevada Street, University of Illinois Urbana-Champaign, 61801, United States
| | - Shang-Ju Li
- Americares, 88 Hamilton Avenue, Stamford, CT 06902, United States
| | - Yuan Hsiao
- Department of Sociology, University of Washington, 211 Savery Hall, Box 353340, Seattle, WA 98195-3340, United States
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Sciberras J, Camilleri LM, Cuschieri S. The burden of type 2 diabetes pre-and during the COVID-19 pandemic - a review. J Diabetes Metab Disord 2020; 19:1357-1365. [PMID: 33102262 PMCID: PMC7570404 DOI: 10.1007/s40200-020-00656-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022]
Abstract
Introduction Diabetes Mellitus is a chronic disease and a global epidemic. It is a known fact that co-morbidities, including Diabetes Mellitus, pose a higher risk of infection by COVID-19. Additionally, the outcomes following infection are far worse than in people without such co-morbities.Factors contributing to the development of type 2 diabetes mellitus (T2DM) have long been established, yet this disease still bestows a substantial global burden. The aim was to provide a comprehensive review of the burden of diabetes pre-COVID-19 and the additional impact sustained by the diabetes population and healthcare systems during the COVID-19 pandemic, while providing recommendations of how this burden can be subsided. Methodology Literature searches were carried out on 'Google Scholar' and 'PubMed' to identify relevant articles for the scope of this review. Information was also collected from reliable sources such as the World Health Organisation and the International Diabetes Federation. Results T2DM presented with economic, social and health burdens prior to COVID-19 with an significant 'Disability Adjusted Life Years' impact. Whilst people with diabetes are more susceptible to COVID-19, enforcing lockdown regulations set by the Public Health department to reduce risk of infection brought about its own challenges to T2DM management. Through recommendations and adapting to new methods of management such as telehealth, these challenges and potential consequences of mismanagement are kept to a minimum whilst safeguarding the healthcare system. Conclusion By understanding the challenges and burdens faced by this population both evident pre-covid and during, targeted healthcare can be provided during the COVID-19 pandemic. Furthermore, implementation of targeted action plans and recommendations ensures the care provided is done in a safe and effective environment.
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Affiliation(s)
| | | | - Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Hassan S, Nguyen M, Buchanan M, Grimshaw A, Adams OP, Hassell T, Ragster L, Nunez-Smith M. Management Of Chronic Noncommunicable Diseases After Natural Disasters In The Caribbean: A Scoping Review. Health Aff (Millwood) 2020; 39:2136-2143. [PMID: 33284688 PMCID: PMC8142319 DOI: 10.1377/hlthaff.2020.01119] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Extreme weather events in the Caribbean region are becoming increasingly severe because of climate change. The region also has high rates of poorly controlled chronic noncommunicable diseases (NCDs), which were responsible for at least 30 percent of deaths after two recent hurricanes. We conducted a scoping review of literature published between 1974 and 2020 to understand the burden and management of chronic NCDs in the Caribbean after natural disasters. Of the twenty-nine articles included in this review, most described experiences related to Hurricanes Dorian (2019) and Irma and Maria (2017) and the Haiti earthquake (2010). Challenges included access to medication, acute care services, and appropriate food, as well as communication difficulties and reliance on ad hoc volunteers and outside aid. Mitigating these challenges requires different approaches, including makeshift points of medication dispensing, disease surveillance systems, and chronic disease self-management education programs. Evidence is needed to inform policies to build resilient health systems and integrate NCD management into regional and national disaster preparedness and response plans.
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Affiliation(s)
- Saria Hassan
- Saria Hassan is an assistant professor at the Emory School of Medicine and Rollins School of Public Health, Emory University, in Atlanta, Georgia. At the time of manuscript submission, she was an instructor of internal medicine at the Yale School of Medicine, Yale University, in New Haven, Connecticut
| | - Mytien Nguyen
- Mytien Nguyen is a student in the MD/PhD program at the Yale School of Medicine
| | - Morgan Buchanan
- Morgan Buchanan is a student in the Department of Social and Behavioral Sciences at the Yale School of Public Health, Yale University
| | - Alyssa Grimshaw
- Alyssa Grimshaw is a clinical research and education librarian in Clinical Information Services at Yale University
| | - Oswald P Adams
- Oswald P. Adams is the dean of the Faculty of Medical Sciences at the University of the West Indies, Cave Hill, in Bridgetown, Barbados
| | - Trevor Hassell
- Trevor Hassell is the president of the Healthy Caribbean Coalition, in Bridgetown, Barbados
| | - LaVerne Ragster
- LaVerne Ragster is a retired professor and president emerita at the University of the Virgin Islands, in St. Thomas, US Virgin Islands
| | - Marcella Nunez-Smith
- Marcella Nunez-Smith is an associate professor of medicine in the Department of Internal Medicine and director of the Equity Research and Innovation Center, both at the Yale School of Medicine
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Eryurt MA, Menet MG. Noncommunicable Diseases Among Syrian Refugees in Turkey: An Emerging Problem for a Vulnerable Group. J Immigr Minor Health 2020; 22:44-49. [PMID: 31123913 DOI: 10.1007/s10903-019-00900-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Turkey hosts 3.6 million Syrian refugees, which is the highest number of refugees in a single country worldwide. In this study, we examined the status of noncommunicable diseases and their risk factors among Syrian refugees in Turkey. The data for the study come from the 2016 Health Status Survey of Syrian Refugees in Turkey. We used logistic regression and descriptive statistics to analyze four major noncommunicable diseases and their risk factors to assess the health status of Syrians under temporary protection in Turkey. Combined risk factor analysis showed that, as age increases, the risk of having a noncommunicable disease increases: Syrians in Turkey 60-69 years old have the highest risk of noncommunicable diseases followed by those 45-59 years old. Men have a higher risk of noncommunicable diseases than women. The noncommunicable disease status of Syrians in Turkey should be considered given the high economic burden of treatment and the potential length of stay of Syrians in Turkey.
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Affiliation(s)
- Mehmet Ali Eryurt
- Department of Demography, Institute of Population Studies, Hacettepe University, Ankara, Turkey
| | - Mevlüde Gül Menet
- Department of Demography, Institute of Population Studies, Hacettepe University, Ankara, Turkey.
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Legido-Quigley H, Leh Hoon Chuah F, Howard N. Southeast Asian health system challenges and responses to the 'Andaman Sea refugee crisis': A qualitative study of health-sector perspectives from Indonesia, Malaysia, Myanmar, and Thailand. PLoS Med 2020; 17:e1003143. [PMID: 33170834 PMCID: PMC7654775 DOI: 10.1371/journal.pmed.1003143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 09/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Southeast Asian countries host signficant numbers of forcibly displaced people. This study was conducted to examine how health systems in Southeast Asia have responded to the health system challenges of forced migration and refugee-related health including the health needs of populations affected by forced displacement; the health systems-level barriers and facilitators in addressing these needs; and the implications of existing health policies relating to forcibly displaced and refugee populations. This study aims to fill in the gap in knowledge by analysing how health systems are organised in Southeast Asia to address the health needs of forcibly displaced people. METHODS AND FINDINGS We conducted 30 semistructured interviews with health policy-makers, health service providers, and other experts working in the United Nations (n = 6), ministries and public health (n = 5), international (n = 9) and national civil society (n = 7), and academia (n = 3) based in Indonesia (n = 6), Malaysia (n = 10), Myanmar (n = 6), and Thailand (n = 8). Data were analysed thematically using deductive and inductive coding. Interviewees described the cumulative nature of health risks at each migratory phase. Perceived barriers to addressing migrants' cumulative health needs were primarily financial, juridico-political, and sociocultural, whereas key facilitators were many health workers' humanitarian stance and positive national commitment to pursuing universal health coverage (UHC). Across all countries, financial constraints were identified as the main challenges in addressing the comprehensive health needs of refugees and asylum seekers. Participants recommended regional and multisectoral approaches led by national governments, recognising refugee and asylum-seeker contributions, and promoting inclusion and livelihoods. Main study limitations included that we were not able to include migrant voices or those professionals not already interested in migrants. CONCLUSIONS To our knowledge, this is one of the first qualitative studies to investigate the health concerns and barriers to access among migrants experiencing forced displacement, particularly refugees and asylum seekers, in Southeast Asia. Findings provide practical new insights with implications for informing policy and practice. Overall, sociopolitical inclusion of forcibly displaced populations remains difficult in these four countries despite their significant contributions to host-country economies.
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Affiliation(s)
- Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Fiona Leh Hoon Chuah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Papautsky EL, Hamlish T. Patient-reported treatment delays in breast cancer care during the COVID-19 pandemic. Breast Cancer Res Treat 2020; 184:249-254. [PMID: 32772225 PMCID: PMC7415197 DOI: 10.1007/s10549-020-05828-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE The coronavirus disease (COVID-19) pandemic has had a profound impact on cancer care in the US Guidelines focused on the management of COVID-19, rather than healthcare needs of breast cancer patients requiring access to crucial services. This US survey of breast cancer survivors characterizes treatment delays early period in the pandemic. METHODS We developed a survey and administered it to 609 adult breast cancer survivors in the US. We used snowball sampling with invitations distributed via social media. We used logistic regression to select a model of delay from a pool of independent variables including race, cancer stage, site of care, health insurance, and age. We used descriptive statistics to characterize delay types. RESULTS Forty-four percent of participants reported cancer care treatment delays during the pandemic. Delays in all aspects of cancer care and treatment were reported. The only variable which had a significant effect was age (97 (.95, 99), p < 0.001) with younger respondents (M = 45.94, SD = 10.31) reporting a higher incidence of delays than older respondents (M = 48.98, SD = 11.10). There was no significant effect for race, insurance, site of care, or cancer stage. CONCLUSIONS Our findings reveal a pervasive impact of COVID-19 on breast cancer care and a gap in disaster preparedness that leaves cancer survivors at risk for poor outcomes. Delays are critical to capture and characterize to help cancer providers and healthcare systems develop effective and patient-tailored processes and strategies to manage cases during the current pandemic wave, subsequent waves, and future disasters.
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Affiliation(s)
- Elizabeth Lerner Papautsky
- Department of Biomedical & Health Information Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA.
| | - Tamara Hamlish
- University of Illinois Cancer Center, University of Illinois at Chicago, 818 S. Wolcott Ave., Chicago, IL, 60612, USA
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Ratnayake R, Rawashdeh F, AbuAlRub R, Al-Ali N, Fawad M, Bani Hani M, Goyal R, Greenough PG, Al-Amire K, AlMaaitah R, Parmar P. Access to Care and Prevalence of Hypertension and Diabetes Among Syrian Refugees in Northern Jordan. JAMA Netw Open 2020; 3:e2021678. [PMID: 33052405 PMCID: PMC7557515 DOI: 10.1001/jamanetworkopen.2020.21678] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE The management of noncommunicable diseases in humanitarian crises has been slow to progress from episodic care. Understanding disease burden and access to care among crisis-affected populations can inform more comprehensive management. OBJECTIVE To estimate the prevalence of hypertension and diabetes with biological measures and to evaluate access to care among Syrian refugees in northern Jordan. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was undertaken from March 25 to April 26, 2019, in the districts of Ramtha and Mafraq, Jordan. Seventy clusters of 15 households were randomly sampled, and chain referral was used to sample Syrian households, representative of 59 617 Syrian refugees. Adults were screened and interviewed about their access to care. Data analysis was performed from May to September 2019. EXPOSURES Primary care delivered through a humanitarian organization since 2012. MAIN OUTCOMES AND MEASURES The main outcomes were self-reported prevalence of hypertension and diabetes among adults aged 18 years or older and biologically based prevalence among adults aged 30 years or older. The secondary outcome was access to care during the past month among adults aged 18 years or older with a diagnosis of hypertension or diabetes. RESULTS In 1022 randomly sampled households, 2798 adults aged 18 years or older, including 275 with self-reported diagnoses (mean [SD] age, 56.5 [13.2] years; 174 women [63.3%]), and 915 adults aged 30 years or older (608 women [66.5%]; mean [SD] age, 46.0 [12.8] years) were screened for diabetes and hypertension. Among adults aged 18 years or older, the self-reported prevalence was 17.2% (95% CI, 15.9%-18.6%) for hypertension, 9.8% (95% CI, 8.6%-11.1%) for diabetes, and 7.3% (95% CI, 6.3%-8.5%) for both conditions. Among adults aged 30 years or older, the biologically based prevalence was 39.5% (95% CI, 36.4%-42.6%) for hypertension, 19.3% (95% CI, 16.7%-22.1%) for diabetes, and 13.5% (95% CI, 11.4%-15.9%) for both conditions. Adjusted for age and sex, prevalence for all conditions increased with age, and women had a higher prevalence of diabetes than men (adjusted prevalence ratio, 1.3%; 95% CI, 1.0%-1.7%), although the difference was not significant. Complications (57.4%; 95% CI, 51.5%-63.1%) and obese or overweight status (82.8%; 95% CI, 79.7%-85.5%) were highly prevalent. Among adults aged 30 years or older with known diagnoses, 94.1% (95% CI, 90.9%-96.2%) currently took medication. Among adults aged 18 years or older with known diagnoses, 26.8% (95% CI, 21.3%-33.1%) missed a medication dose in the past week, and 49.1% (95% CI, 43.3%-54.9%) sought care in the last month. CONCLUSIONS AND RELEVANCE During this protracted crisis, obtaining care for noncommunicable diseases was feasible, as demonstrated by biologically based prevalence that was only moderately higher than self-reported prevalence. The high prevalence of complications and obese or overweight status, however, suggest inadequate management. Programs should focus on reinforcing adherence and secondary prevention to minimize severe morbidity.
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Affiliation(s)
- Ruwan Ratnayake
- International Rescue Committee, Amman, Jordan
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Raeda AbuAlRub
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Nahla Al-Ali
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Ravi Goyal
- Mathematica Policy Research Inc, Princeton, New Jersey
| | - P. Gregg Greenough
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Rowaida AlMaaitah
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Parveen Parmar
- Division of Global Emergency Medicine, University of Southern California, Los Angeles
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Maconick L, Ansbro É, Ellithy S, Jobanputra K, Tarawneh M, Roberts B. "To die is better for me", social suffering among Syrian refugees at a noncommunicable disease clinic in Jordan: a qualitative study. Confl Health 2020; 14:63. [PMID: 32905304 PMCID: PMC7465779 DOI: 10.1186/s13031-020-00309-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The conflict in Syria has required humanitarian agencies to implement primary-level services for non-communicable diseases (NCDs) in Jordan, given the high NCD burden amongst Syrian refugees; and to integrate mental health and psychosocial support into NCD services given their comorbidity and treatment interactions. However, no studies have explored the mental health needs of Syrian NCD patients. This paper aims to examine the interaction between physical and mental health of patients with NCDs at a Médecins Sans Frontières (MSF) clinic in Irbid, Jordan, in the context of social suffering. METHODS This qualitative study involved sixteen semi-structured interviews with Syrian refugee and Jordanian patients and two focus groups with Syrian refugees attending MSF's NCD services in Irbid, and eighteen semi-structured interviews with MSF clinical, managerial and administrative staff. These were conducted by research staff in August 2017 in Irbid, Amman and via Skype. Thematic analysis was used. RESULTS Respondents describe immense suffering and clearly perceived the interconnectedness of their physical wellbeing, mental health and social circumstances, in keeping with Kleinman's theory of social suffering. There was a 'disconnect' between staff and patients' perceptions of the potential role of the NCD and mental health service in alleviating this suffering. Possible explanations identified included respondent's low expectations of the ability of the service to impact on the root causes of their suffering, normalisation of distress, the prevailing biomedical view of mental ill-health among national clinicians and patients, and humanitarian actors' own cultural standpoints. CONCLUSION Syrian and Jordanian NCD patients recognise the psychological dimensions of their illness but may not utilize clinic-based humanitarian mental health and psychosocial support services. Humanitarian agencies must engage with NCD patients to elicit their needs and design culturally relevant services.
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Affiliation(s)
- Lucy Maconick
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Éimhín Ansbro
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH UK
| | | | | | | | - Bayard Roberts
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH UK
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Huang Y, Zhu P, Chen L, Wang X, Valentijn P. Validation of the care providers version of the Rainbow Model of Integrated Care-measurement tool in Chinese primary care systems. BMC Health Serv Res 2020; 20:727. [PMID: 32770995 PMCID: PMC7414573 DOI: 10.1186/s12913-020-05562-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. To translate and adapt the original care provider version of the RMIC-MT and evaluate its psychometric properties by a pilot study in Chinese primary care systems. Methods The translation and adaptation process were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a cross-sectional study with 1610 community care professionals in all 79 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method and promax rotation was used to assess the construct validity. Cronbach’s alpha was utilized to ascertain the internal consistency reliability. Lastly, confirmation factor analysis was used to evaluate the exploratory factor analysis model fit. Results During the translation and adaptation process, all 48 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Six factors (person- & community-centeredness, care integration, professional integration, organizational integration, cultural competence and technical competence) with 45 items were determined by exploratory factor analysis, accounting for 61.46% of the total variance. A standard Cronbach’s alpha of 0.940 and significant correlation among all items in the scale (> 0.4) showed good internal consistency reliability of the tool. And, the model passed the majority of goodness-to-fit test by confirmation factor analysis. Conclusions The results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT provider version. Its application in China will promote the development of people-centered integrated primary care. However, further psychometric testing is needed in multiple primary care settings with both public and private community institutes.
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Affiliation(s)
- Yixiang Huang
- School of Public Health, Health Development Research Center, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Paiyi Zhu
- School of Public Health, Health Development Research Center, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Lijin Chen
- School of Public Health, Health Development Research Center, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xin Wang
- School of Public Health, Health Development Research Center, Sun Yat-Sen University, Guangzhou, 510080, China.
| | - Pim Valentijn
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Integrated Care Evaluation, Essenburgh, Hierden, The Netherlands
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48
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Abdul-Khalek RA, Guo P, Sharp F, Gheorghe A, Shamieh O, Kutluk T, Fouad F, Coutts A, Aggarwal A, Mukherji D, Abu-Sittah G, Chalkidou K, Sullivan R. The economic burden of cancer care for Syrian refugees: a population-based modelling study. Lancet Oncol 2020; 21:637-644. [PMID: 32359488 DOI: 10.1016/s1470-2045(20)30067-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cancer represents a substantial health burden for refugees and host countries. However, no reliable data on the costs of cancer care for refugees are available, which limits the planning of official development assistance in humanitarian settings. We aimed to model the direct costs of cancer care among Syrian refugee populations residing in Jordan, Lebanon, and Turkey. METHODS In this population-based modelling study, direct cost per capita and per incident case for cancer care were estimated using generalised linear models, informed by a representative dataset of cancer costs drawn from 27 EU countries. A range of regression specifications were tested, in which cancer costs were modelled using different independent variables: gross domestic product (GDP) per capita, crude or age-standardised incidence, crude or age-standardised mortality, and total host country population size. Models were compared using the Akaike information criterion. Total cancer care costs for Syrian refugees in Jordan, Lebanon, and Turkey were calculated by multiplying the estimated direct cancer care costs (per capita) by the total number of Syrian refugees, or by multiplying the estimated direct cancer costs (per incident case [crude or age-standardised]) by the number of incident cancer cases in Syrian refugee populations. All costs are expressed in 2017 euros (€). FINDINGS Total cancer care costs for all 4·74 million Syrian refugees in Jordan, Lebanon, and Turkey in 2017 were estimated to be €140·23 million using the cost per capita approach, €79·02 million using the age-standardised incidence approach, and €33·68 million using the crude incidence approach. Under the lowest estimation, and with GDP and total country population as model predictors, the financial burden of cancer care was highest for Turkey (€25·18 million), followed by Lebanon (€6·40 million), and then Jordan (€2·09 million). INTERPRETATION Cancer among the Syrian refugee population represents a substantial financial burden for host countries and humanitarian agencies, such as the UN Refugee Agency. New ways to provide financial assistance need to be found and must be coupled with clear, prioritised pathways and models of care for refugees with cancer. FUNDING UK Research and Innovation Global Challenges Research Fund: Research for Health in Conflict-Middle East and North Africa region (R4HC-MENA).
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Affiliation(s)
- Rima A Abdul-Khalek
- Global Health Institute, American University of Beirut, Beirut, Lebanon; Conflict and Health Research Group, School of Security Studies, King's College London, London, UK
| | - Ping Guo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Forbes Sharp
- Conflict and Health Research Group, School of Security Studies, King's College London, London, UK; Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Adrian Gheorghe
- School of Public Health, Department of Infectious Disease Epidemiology and Global Health and Development Group, Imperial College London, London, UK
| | - Omar Shamieh
- Centre for Palliative and Cancer Care in Conflict, King Hussein Cancer Centre, Amman, Jordan
| | - Tezer Kutluk
- Centre for Palliative and Cancer Care in Conflict, Hacettepe University, Ankara, Turkey
| | - Fouad Fouad
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Adam Coutts
- Department of Sociology and Magdalene College, University of Cambridge, Cambridge, UK
| | - Ajay Aggarwal
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Deborah Mukherji
- Global Health Institute, American University of Beirut, Beirut, Lebanon; Conflict and Health Research Group, School of Security Studies, King's College London, London, UK
| | - Ghassan Abu-Sittah
- Global Health Institute, American University of Beirut, Beirut, Lebanon; Conflict and Health Research Group, School of Security Studies, King's College London, London, UK
| | - Kalipso Chalkidou
- School of Public Health, Department of Infectious Disease Epidemiology and Global Health and Development Group, Imperial College London, London, UK; Centre for Global Development, Washington, DC, USA
| | - Richard Sullivan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK.
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Carruth L, Ateye MJ, Nassir A, Hosh FM, Mendenhall E. Diabetes in a humanitarian crisis: Atypical clinical presentations and challenges to clinical- and community-based management among Somalis in Ethiopia. Glob Public Health 2020; 15:828-839. [PMID: 31994445 DOI: 10.1080/17441692.2020.1718735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study was designed to better understand the clinical presentations and challenges of managing type-2 diabetes mellitus (T2DM) in a humanitarian crisis-affected population. Findings are based on a long-term ethnographic study of humanitarian response in eastern Ethiopia by the first author from 2008 to 2018, and in addition, a mixed-method case study of T2DM in July-August 2018. For the case study, the authors collected anthropometric, demographic, and biological data from 85 persons with T2DM diagnosis and 23 of their adult siblings. The team then conducted participant-observation and 28 ethnographic interviews with a purposive sample of patients, their siblings, and local health providers, policymakers, and aid workers. T2DM was characterised in this sample by progressive weight loss, weakness, lethargy, loss of teeth, and persistently high average blood glucose levels (HbA1c), at initial clinical presentation, and then in subsequent years, even while taking prescribed medications and/or insulin. Patients struggled to access medical care, refrigerate insulin, and follow dietary recommendations due to chronic food insecurity and long-term dependence on limited food aid rations. Local health providers who are trained and supplied mostly through humanitarian relief funding lack the education and resources to effectively help patients manage non-communicable chronic conditions.
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Affiliation(s)
- Lauren Carruth
- School of International Service, American University, Washington, DC, USA
| | - Mohamed Jama Ateye
- School of International Service, Norwegian Refugee Council, American University, Jigjiga, Ethiopia
| | - Ahmed Nassir
- Elahelay Health Post, Aysha Woreda Health Bureau, Aysha, Ethiopia
| | - Farah Mussa Hosh
- School of International Service, American University, Dire Dawa, Ethiopia
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
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Ansbro ÉM, Biringanine M, Caleo G, Prieto-Merino D, Sadique Z, Perel P, Jobanputra K, Roberts B. Management of diabetes and associated costs in a complex humanitarian setting in the Democratic Republic of Congo: a retrospective cohort study. BMJ Open 2019; 9:e030176. [PMID: 31767582 PMCID: PMC6887084 DOI: 10.1136/bmjopen-2019-030176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We aimed to evaluate an Integrated Diabetic Clinic within a Hospital Outpatient Department (IDC-OPD) in a complex humanitarian setting in North Kivu, Democratic Republic of Congo. Specific objectives were to: (1) analyse diabetes intermediate clinical and programmatic outcomes (blood pressure (BP)/glycaemic control, visit volume and frequency); (2) explore the association of key insecurity and related programmatic events with these outcomes; and (3) describe incremental IDC-OPD programme costs. DESIGN Retrospective cohort analysis of routine programmatic data collected from January 2014 to February 2017; analysis of programme costs for 2014/2015. SETTING Outpatient diabetes programme in Mweso hospital, supported by Médecins sans Frontières, in North Kivu, Demographic Republic of Congo. PARTICIPANTS Diabetes patients attending IDC-OPD. OUTCOME MEASURES Intermediate clinical and programmatic outcome trends (BP/ glycaemic control; visit volume/frequency); incremental programme costs. RESULTS Of 243 diabetes patients, 44.6% were women, median age was 45 (IQR 32-56); 51.4% were classified type 2. On introduction of IDC-OPD, glucose control improved and patient volume and visit interval increased. During insecurity, control rates were initially maintained by a nurse-provided, scaled-back service, while patient volume and visit interval decreased. Following service suspension due to drug stock-outs, patients were less likely to achieve control, improving on service resumption. Total costs decreased 16% from 2014 (€36 573) to 2015 (€30 861). Annual cost per patient dropped from €475 in 2014 to €214 in 2015 due to reduced supply costs and increased patient numbers. CONCLUSIONS In a chronic conflict setting, we documented that control of diabetes intermediate outcomes was achievable during stable periods. During insecure periods, a simplified, nurse-led model maintained control rates until drug stock-outs occurred. Incremental per patient annual costs were lower than chronic HIV care costs in low-income settings. Future operational research should define a simplified diabetes care package including emergency preparedness.
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Affiliation(s)
- Éimhín Mary Ansbro
- Manson Unit, Médecins sans Frontières, London, UK
- Centre for Global Chronic Conditions, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Michel Biringanine
- Mweso Hospital, Médecins Sans Frontières Operational Centre Amsterdam, Mweso, Congo (the Democratic Republic of the)
| | - Grazia Caleo
- Manson Unit, Médecins sans Frontières, London, UK
| | - David Prieto-Merino
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Zia Sadique
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pablo Perel
- Centre for Global Chronic Conditions, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Bayard Roberts
- Centre for Global Chronic Conditions, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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