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R S, R A, P P. Root Cause Analysis of Gaps in Non-communicable Disease Monitoring in a Sub-district Hospital, Tamil Nadu: A Quality Improvement Initiative. Cureus 2024; 16:e57095. [PMID: 38681427 PMCID: PMC11053342 DOI: 10.7759/cureus.57095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Non-communicable diseases (NCDs) present a significant public health challenge globally, and India is deeply affected. With the largest population in the world, India struggles with a high burden of NCDs, encompassing cardiovascular diseases, diabetes, cancer, and chronic respiratory conditions. These ailments contribute substantially to morbidity and mortality, placing a strain on healthcare systems. Despite efforts through public health initiatives, NCD monitoring and management remain deficient, especially at grassroots levels. Methods At a sub-district hospital in Tamil Nadu, India, a quality improvement initiative targeted diabetes and hypertension, prevalent NCDs. Utilizing Fishbone analysis and process flow diagrams, we identified gaps in NCD monitoring. Employing the Plan-Do-Study-Act model and reorienting the patient flow, we enhanced NCD monitoring by optimizing patient health record maintenance within the hospital. Results Root cause analysis identified a lack of patient record protocols and patient loss of records as key hindrances in NCD monitoring. We revamped patient flow and implemented a robust record-keeping system, boosting access to patient health records. This initiative was embraced by healthcare providers, enhancing NCD management. Leveraging these records, we assessed control rates of diabetes and hypertension patients effectively. Conclusion The research underscores the importance of maintaining comprehensive patient health records in healthcare centers for enhancing NCD monitoring. These records serve as valuable tools for healthcare providers, aiding in the monitoring and treatment of patients with diabetes and hypertension. By leveraging these records, healthcare providers can achieve better disease control outcomes, thereby improving the overall management of NCDs.
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Affiliation(s)
- Stalin R
- Community Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, IND
| | - Angusubalakshmi R
- Community Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, IND
| | - Priya P
- Community Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, IND
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Calderwood CJ, Marambire E, Nzvere FP, Larsson LS, Chingono RMS, Kavenga F, Redzo N, Bandason T, Rusakaniko S, Mujuru HA, Simms V, Khan P, Gregson CL, Ndhlovu CE, Ferrand RA, Fielding K, Kranzer K. Prevalence of chronic conditions and multimorbidity among healthcare workers in Zimbabwe: Results from a screening intervention. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002630. [PMID: 38261562 PMCID: PMC10805297 DOI: 10.1371/journal.pgph.0002630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/27/2023] [Indexed: 01/25/2024]
Abstract
The burden of non-communicable diseases (NCDs) in southern Africa is expanding and is superimposed on high HIV prevalence. Healthcare workers are a scarce resource; yet are vital to health systems. There are very limited studies on the burden of chronic conditions among healthcare workers in Africa, and none exploring multimorbidity (≥2 chronic conditions). We describe the epidemiology of infectious (HIV) and non-communicable chronic conditions, and multimorbidity, among Zimbabwean healthcare workers. Healthcare workers (≥18 years) in eight Zimbabwean provinces were invited to a voluntary, cross-sectional health-check, including HIV, diabetes, hypertension and mental health screening. Statistical analyses described the prevalence and risk factors for multimorbidity (two or more of HIV, diabetes, hypertension or common mental disorder) and each condition. Missing data were handled using multiple imputation. Among 6598 healthcare workers (July 2020-July 2022) participating in the health-check, median age was 37 years (interquartile range 29-44), 79% were women and 10% knew they were living with HIV. Half had at least one chronic condition: 11% were living with HIV, 36% had elevated blood pressure, 12% had elevated HbA1c and 11% had symptoms of common mental disorder. The overall prevalence of multimorbidity was 15% (95% CI: 13-17%); 39% (95% CI: 36-43%) among people aged 50 and older. Whilst most HIV was diagnosed and treated, other chronic conditions were usually undiagnosed or uncontrolled. Limiting our definition of multimorbidity to two or more screened conditions sought to reduce bias due to access to diagnosis, however, may have led to a lower reported prevalence than that found using a wider definition. Half of healthcare workers screened were living with a chronic condition; one in seven had multimorbidity. Other than HIV, most conditions were undiagnosed or untreated. Multisectoral action to implement contextually relevant, chronic disease services in Africa is urgently needed. Specific attention on health workers is required to protect and retain this critical workforce.
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Affiliation(s)
- Claire Jacqueline Calderwood
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Edson Marambire
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
| | - Farirai Peter Nzvere
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Leyla Sophie Larsson
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
| | - Rudo M. S. Chingono
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Fungai Kavenga
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- AIDS & TB Control Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Nicole Redzo
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Hilda A. Mujuru
- Faculty of Medicine and Health Sciences, Child and Adolescent Health Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Victoria Simms
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Data Science Unit, Africa Health Research Institute, Durban, South Africa
| | - Palwasha Khan
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Data Science Unit, Africa Health Research Institute, Durban, South Africa
| | - Celia Louise Gregson
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Global Health and Ageing Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Chiratidzo E. Ndhlovu
- Internal Medicine Unit, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rashida Abbas Ferrand
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katharina Kranzer
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Health Research Unit Zimbabwe, Biomedical Research & Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
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3
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Al-Bataineh RT, Al-Hammouri MM, Al-Jaraideh WK. Perspective of healthcare providers on assessing the quality and accessibility of health services for chronic diseases in Jordan during Covid-19: a mixed method study. BMC Health Serv Res 2023; 23:895. [PMID: 37612605 PMCID: PMC10464245 DOI: 10.1186/s12913-023-09919-1] [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: 01/11/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Hospital services in all parts of the world were severely affected by the crisis caused by the Coronavirus pandemic. This was particularly concerning for patients who suffer from chronic diseases. AIM This study aimed to: assess the level of quality and accessibility of chronic disease services from the perspectives of healthcare providers, assess the association between healthcare providers' socio-demographic factors and their perspectives on accessibility and quality level, and explore the providers' perspectives on the barriers and facilitators of quality and accessibility to chronic disease health services during the COVID -19 pandemic. METHOD Design: An explanatory mixed method design was employed in this study using a questionnaire and focus group discussion approach. The questionnaire consisted of three sections including, demographic, accessibility, and quality. SAMPLE A convenience sampling approach was used to collect the quantitative from 412 healthcare providers working at public, private, and teaching hospitals. A purposive sample of 12 healthcare providers were interviewed to collect the qualitative data. ANALYSIS The quantitative data were analyzed using SPSS Statistics Version 25. The qualitative data was analyzed using the thematic analysis approach. RESULTS This study found that the quality and accessibility of chronic disease services in northern Jordan were affected during COVID-19. Quantitative: The majority of the participants reported moderate level of accessibility and quality. Qualitative: Four main and six subthemes were identified: 1) Accessibility barriers including transportation and fear of infection; 2) Accessibility facilitators including availability of Personal Protective Equipment (PPE) and Covid-19 vaccination; 3) Quality barriers including staff shortage; 4) Quality facilitators including safety protocol. CONCLUSION The quality and accessibility of chronic disease services were affected due to the healthcare system restating to address the Covid-19 pandemic. Different barriers and facilitators for chronic disease healthcare services accessibility and quality were identified. The findings of this study lay the ground for healthcare decision and policymakers to develop strategies and formulate polices to ensure these patients receive the needed healthcare services, and hence improve their health outcomes.
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Affiliation(s)
- Raya T Al-Bataineh
- Department of Health Management and Policy, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Mohammed M Al-Hammouri
- Department of Community and Mental Health, College of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Wafa'a K Al-Jaraideh
- Department of Health Management and Policy, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Rameez S, Nasir A. Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-covid era: A systematic review. J Family Med Prim Care 2023; 12:1485-1504. [PMID: 37767443 PMCID: PMC10521856 DOI: 10.4103/jfmpc.jfmpc_391_22] [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: 02/15/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 09/29/2023] Open
Abstract
General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health-trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.
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Affiliation(s)
- Sahar Rameez
- Student Health and Wellbeing Organization (SHAW), Pakistan
| | - Almas Nasir
- Pakistan Association of Lifestyle Medicine, Pakistan
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Shamsuddin S, Davis K, Moorhouse L, Mandizvidza P, Maswera R, Dadirai T, Nyamukapa C, Gregson S, Chigogora S. Relationship between psychological distress, health behaviours and future reports of hypertension among adults in East Zimbabwe: a cohort study. Open Heart 2023; 10:e002346. [PMID: 37385733 DOI: 10.1136/openhrt-2023-002346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Extensive cross-sectional evidence has demonstrated an association between psychological distress (PD) and hypertension. However, evidence on the temporal relationship is limited, especially in low-income and middle-income countries. The role of health risk behaviours including smoking and alcohol consumption in this relationship is also largely unknown. The aim of this study was to investigate the association between PD and later development of hypertension, and how this association may have been influenced by health risk behaviours, among adults in east Zimbabwe. METHODS The analysis included 742 adults (aged 15-54 years) recruited by the Manicaland general population cohort study, who did not have hypertension at baseline in 2012-2013, and who were followed until 2018-2019. In 2012-2013, PD was measured using the Shona Symptom Questionnaire, a screening tool validated for use in Shona-speaking countries including Zimbabwe (cut-off point: 7). Smoking, alcohol consumption and use of drugs (health risk behaviours) were also self-reported. In 2018-2019, participants reported if they had diagnosed with hypertension by a doctor or nurse. Logistic regression was used to assess the association between PD and hypertension. RESULTS In 2012, 10.4% of the participants had PD. The odds of new reports of hypertension were 2.04 times greater (95% CI 1.16 to 3.59) among those with PD at baseline, after adjusting for sociodemographic and health risk behaviour variables. Female gender (adjusted odds ratio, AOR 6.89, 95% CI 2.71 to 17.53), older age (AOR 2.67, 95% CI 1.63 to 4.42), and greater wealth (AOR 2.10, 95% CI 1.04 to 4.24 more wealthy, 2.88, 95% CI 1.24 to 6.67 most wealthy) were significant risk factors for hypertension. The AOR for the relationship between PD and hypertension did not differ substantially between models with and without health risk behaviours. CONCLUSION PD was associated with an increased risk of later reports of hypertension in the Manicaland cohort. Integrating mental health and hypertension services within primary healthcare may reduce the dual burden of these non-communicable diseases.
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Affiliation(s)
- Shehla Shamsuddin
- Department of Health and Social Care, UK Government, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Katherine Davis
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Louisa Moorhouse
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Phyllis Mandizvidza
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rufurwokuda Maswera
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tawanda Dadirai
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Constance Nyamukapa
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Simon Gregson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Sungano Chigogora
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
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Pencil A, Matsungo TM, Hongu N, Hayami N. Prevalence of Obesity and the Factors Associated with Low Obesity Awareness among Urban Adolescents in Harare, Zimbabwe. Nutrients 2023; 15:nu15102302. [PMID: 37242185 DOI: 10.3390/nu15102302] [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: 04/26/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Obesity is a global health problem. In developing countries such as Zimbabwe, obesity is both an emerging health problem and a grey area, particularly among adolescents. This study assessed the prevalence of obesity and factors associated with low obesity awareness among adolescents. METHOD A cross-sectional survey was performed using an interviewer-administered questionnaire. The participants were 423 adolescents aged 14-19 years recruited from 10 schools in Harare using a stratified random sampling technique. Data were analyzed using SPSS software (version 23) and binary logistics regression was used to examine the factors associated with low obesity awareness. The level of significance was set at p < 0.05. RESULTS The median± IQR age was 16 (14-18) years, and overweight and obesity affected 15.8% of the participants with higher proportions among girls (73.1%, p = 0.002). Low obesity awareness was observed in 27.1% of the adolescents with a higher proportion among girls (67.0%, p = 0.001), 14-16-year-olds (51.3%, p = 0.317), and obese adolescents (56.7%, p = 0.001). Significant factors associated with low obesity awareness were household heads lacking formal education [OR = 9.41 (2.20-40.36), p = 0.003] and inadequate (poor) food habits [OR = 2.58 (1.33-5.01), p = 0.005]. CONCLUSIONS Our study showed that adolescents had different obesity awareness levels and diverse perceptions in terms of obesity causes, and a range of potential solutions. Obesity awareness and nutrition education should address adolescents' poor eating habits while taking cognizance of the different education levels of household heads.
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Affiliation(s)
- Ashleigh Pencil
- Graduate School of Human Life Science, Osaka City University, 3 Chome-3-138 Sugimoto, Sumiyoshiku, Osaka 558-8585, Japan
| | - Tonderayi M Matsungo
- Department of Nutrition, Dietetics and Food Sciences (DNDFS), University of Zimbabwe, Mt Pleasant, Harare P.O. Box MP167, Zimbabwe
| | - Nobuko Hongu
- Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3 Chome-3-138 Sugimoto, Sumiyoshiku, Osaka 558-8585, Japan
| | - Naomi Hayami
- Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3 Chome-3-138 Sugimoto, Sumiyoshiku, Osaka 558-8585, Japan
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Stojnić N, Klemenc-Ketiš Z, Mori Lukančič M, Zavrnik Č, Poplas Susič A. Perceptions of the primary health care team about the implementation of integrated care of patients with type 2 diabetes and hypertension in Slovenia: qualitative study. BMC Health Serv Res 2023; 23:362. [PMID: 37046293 PMCID: PMC10091568 DOI: 10.1186/s12913-023-09353-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation. METHODS Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program. RESULTS We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful. CONCLUSION Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team.
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Affiliation(s)
| | - Zalika Klemenc-Ketiš
- Community Health Centre Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | | | - Črt Zavrnik
- Community Health Centre Ljubljana, Ljubljana, Slovenia
| | - Antonija Poplas Susič
- Community Health Centre Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Nair D, Thekkur P, Fernando M, Kumar AMV, Satyanarayana S, Chandraratne N, Chandrasiri A, Attygalle DE, Higashi H, Bandara J, Berger SD, Harries AD. Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study. Healthcare (Basel) 2023; 11:healthcare11020202. [PMID: 36673570 PMCID: PMC9859051 DOI: 10.3390/healthcare11020202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0-23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.
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Affiliation(s)
- Divya Nair
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- Correspondence:
| | - Manoj Fernando
- Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Anuradhapura 50300, Sri Lanka
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union-South East Asia (USEA) Office, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore 575018, India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union-South East Asia (USEA) Office, New Delhi 110016, India
| | - Nadeeka Chandraratne
- The Foundation for Health Promotion, 21/1 Kahawita Road, Dehiwala 10350, Sri Lanka
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka
| | - Amila Chandrasiri
- The Foundation for Health Promotion, 21/1 Kahawita Road, Dehiwala 10350, Sri Lanka
| | | | | | - Jayasundara Bandara
- Project Management Unit, Primary Health Care System Strengthening Project (PSSP), Colombo 00300, Sri Lanka
| | - Selma Dar Berger
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Anthony D. Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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