Care For Chronic Non-communicable Diseases Research Articles

PREVALENCE OF ASTHENIA IN PATIENTS WITH CHRONIC NONCOMMUNICABLE DISEASES IN REAL CLINICAL PRACTICE

The aim of the research. Examine the features of prevalence of asthenia in patients with chronic noncommunicable diseases in real clinical practice.Materials and methods. Research includes 2 373 patients, who are under the general practitioner’s care for chronic noncommunicable diseases. These patients are 1 337 (56,3%) women and 1 036 (43,7%) men. The average age of them is 56,3±15,0 year. We asked about complains, took anamnesis, examined the organs’ systems, and reviewed patients’ cards. According these data we confirmed the diagnosis of chronic noncommunicable disease. We diagnosed asthenia thanks to Multidimensional Fatigue Inventory – 20, MFI-20 and Fatigue Severity Scale, FSS. Statistic data processing was made with applying of Mann–Whitney U testResults. The largest amount of patients, who we examined, have cardiovascular diseases (1 474 patients, 62,1%). More than one half of all examined patients are from 18 to 60 years (1349 patients). According MFI-20, 847 patients have asthenia (35,7%). According FSS, 701 patients have it (29,5%). 57,1% patients with asthenia are people elder 61 year (484 patients). Moreover, 334 citizens among elderly patients have polymorbidity (69,1%). The level of severity of asthenia is utterly higher in patients who elder 61 year (p < 0,001). Patients with multimorbidity have more sever asthenia that patients who have only one disease (p < 0,001).Conclusion. Results of large spread of asthenia in patients with chronic noncommunicable diseases underline the necessity of awareness of general practitioners about right assessment of asthenia in real clinical practice, especially in elderly patients with multimorbidity.

Chronic NCD care in crises: A qualitative study of global experts’ perspectives on models of care for hypertension and diabetes in humanitarian settings

BackgroundThe high and rising global burden of non-communicable diseases (NCDs) is reflected among crisis-affected populations. People living with NCDs are especially vulnerable in humanitarian crises. Limited guidance exists to support humanitarian actors in designing effective models of NCD care for crisis-affected populations in low- and middle-income countries (LMICs). We aimed to synthesise expert opinion on current care models for hypertension and diabetes (HTN/DM) in humanitarian settings in LMICs, to examine the gaps in delivering good quality HTN/DM care and to propose solutions to address these gaps. MethodsWe interviewed twenty global experts, purposively selected based on their expertise in provision of NCD care in humanitarian settings. Data were analysed using a combination of inductive and deductive methods. We used a conceptual framework for primary care models for HTN/DM in humanitarian settings, guided by the WHO health systems model, patient-centred care models and literature on NCD care in LMICs. ResultsHTN/DM care model design was highly dependent on the type of humanitarian crisis, the implementing organisation, the target population, the underlying health system readiness to deal with NCDs and its resilience in the face of crisis. Current models were mainly based at primary-care level, in prolonged crisis settings. Participants focussed on the basic building blocks of care, including training the workforce, and strengthening supply chains and information systems. Intermediate health system goals (responsiveness, quality and safety) and final goals received less attention. There were notable gaps in standardisation and continuity of care, integration with host systems, and coordination with other actors. Participants recommended a health system strengthening approach and aspired to providing patient-centred care. However, more evidence on effective integration and on patients’ priorities and experience is needed. More funding is needed for NCD care and related research. ConclusionsComprehensive guidance would foster standardization, continuity, integration and, thus, better quality care. Future models should take a health system strengthening approach, use patient-centred design, and should be co-created with patients and providers. Those designing new models may draw on lessons learned from existing chronic care models in high- and low-income settings.

Perceived impact of COVID-19 on routine care of patients with chronic non-communicable diseases: a cross-sectional study.

patients with chronic non-communicable diseases (chronic liver diseases, chronic respiratory diseases, neurologic diseases, chronic kidney diseases, cardiovascular diseases, diabetes mellitus, and hypertension), primarily poor, rural and neglected populations, have had difficulty accessing health care and have been severely impacted both socially and financially in during the pandemic. As a result, this study was designed to assess the perceived impact of COVID-19 on routine care of chronic non-communicable disease patients in Ethiopia. a cross-section survey was conducted among 404 participants from April 1st 2021 to May 30th 2021. Data were collected via interviewer administered questionnaires administered by pre-tested interviewers on socio-demographic characteristics, treatment and clinical features and routine care questionnaires that have been adapted and modified from different literatures. The study consisted of all adult outpatients with at least one chronic non-communicable disease who were followed up. Data were analyzed using the Statistical Package for Social Sciences Version 23. of the 422 participants, 404 responded for a response rate of 95.7%. One out of two (203, 50.2%) participants was aged 40 to 50 years. Ninety-one out of hundred (367, 90.8%) participants continued to receive routine care face-to-face during COVID-19. One-third (141, 34.9%) of study participants had good management of the chronic non-communicable diseases care in the middle of pandemic. A total of 167(41.34%) participants thought they were moderately affected changes in healthcare services since the COVID-19 outbreak. Nearly one-third (130, 32.2%) of participants were sometimes affected by medication shortages since the start of COVID-19. this study highlights that most participants continued to receive routine care face-to-face during the COVID-19. About forty-one out of 100 participants perceived that they were moderately affected changes in healthcare services since the outbreak of COVID-19. One-third of participants sometimes perceived that they were affected by medication shortages since the start of COVID-19.

A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi

BackgroundCommunity health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence...

Medication-Related Needs and Humanistic Impact of Patient-Centered Pharmaceutical Care at University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia.

PurposeTo assess patients’ medication-related needs and the humanistic impact of patient-centered pharmaceutical care.Patients and MethodsA hospital-based cross-sectional study was conducted using self-administered structured questionnaires from February 4 to 28, 2019, on patients attending ambulatory care for chronic non-communicable diseases at the University of Gondar specialized teaching hospital, North-west Ethiopia. Data were entered to SPSS version 22 for analysis. Descriptive statistics was used to describe the socio-demographic characteristics and medication-related needs of study participants. Independent sample t-test and one-way ANOVA analysis were performed to check for possible associations between dependent and independent variables.ResultsInformation about what to do if patients missed doses and the potential side-effects or abnormal conditions caused by the prescribed medicines were not explained for most of the 425 patients studied. The majority of the study participants reported that they felt worried about adverse medicine effects, drug interactions, and long-term medicine use. Patients who were older than 50 or those receiving two or more medications were less satisfied with the effect of their medicine as compared to younger ones and those on monotherapy, respectively. People who were illiterate or had attended only primary schools thought that they received less disease and medicine information from health professionals than people who attended tertiary education.Conclusion and RecommendationMost of the participants were particularly unhappy with the amount of information received about side-effects and what to do if doses were missed. Special emphasis should be given to patients with a low level of education as they were not satisfied with medicine and disease information obtained from health professionals, experienced more psychological impacts of medicine use, and had poor overall quality-of-life.

Qualitative evaluation of the general practitioner chronic non-communicable diseases training programme

BackgroundIn China, general practitioners have limited ability to provide care for common chronic non-communicable diseases because they lack postgraduate training. In an attempt to improve general practitioners’ skills in this regard, the present authors previously launched the Chronic Non-Communicable Diseases Training Programme. The present study aims to evaluate the effectiveness of this programme.MethodsThirty-nine trainee general practitioners who participated in the programme underwent semi-structured interviews, which explored how they performed the training, what they achieved from the programme, and their suggestions for future programmes. The interview data were analysed using a thematic analysis approach.ResultsUnder the guidance of supervisors, the thirty-nine trainee general practitioners completed the structured but individualised training plan, which comprised a four-day basic theory class, 3 months practising in a ward, and 6 months assisting in an outpatient clinic. They reported an improvement in their ability to provide care for chronic non-communicable diseases and perform two-way referral, as well as their communication with patients. They also reported that, since returning to their communities, they had become more confident, were building better relationships with their patients, and had changed their clinic behaviours from copying prescriptions to making medical decisions independently. Their principal suggestion for the training programme was to alter the order of the training, as they preferred to practice in the ward before assisting in the outpatient clinic.ConclusionThe course comprised a learner-centred, practice- and apprenticeship-based, general-practitioner training programme. Given the participants’ progress and the beneficial effects of the programme reported in the interview data, it appears to be worthwhile to extend the General Practitioner Chronic Non-Communicable Diseases Training Programme.

Incorporating genomic medicine into primary-level health care for chronic non-communicable diseases in Mexico: A qualitative study.

To analyze the viability of incorporating genomic medicine technology into the process of detecting and diagnosing chronic non-communicable diseases (CNCDs) at primary-care facilities in Mexico, and to discuss its implications for health systems in other countries with similar characteristics. We conducted 29 semi-structured interviews with health authorities as well as providers and users of health services in the state of Morelos. We investigated knowledge of genomic technology among interviewees; the accessibility, management, and organization of health services; and CNCDs prevention, control, and care practices. The incorporation of genomic medicine technology into the CNCDs primary-care process is viable. However, the following challenges were identified: a lack of knowledge and limited information among interviewees regarding the effectiveness and benefits of genomic medicine technology, coupled with the need to mobilize and reassign trained human resources for drawing, registering, safeguarding, transporting, and controlling the quality of the genetic samples, as well as for the outsourcing of private laboratory services. Using genetic information to detect CNCDs at an early stage offers an enormous potential for upgrading CNCDs prevention and control efforts. This, in turn, could translate into more efficient and financially sustainable health systems in Mexico and other low- and middle-income countries.

Gendered effects of pay for performance among family physicians for chronic disease care: an economic evaluation in a context of universal health coverage

BackgroundDespite increasing popularity among health organizations of pay for performance (P4P) for the provision of comprehensive care for chronic non-communicable diseases, evidence of its effectiveness in improving health system outcomes is weak. An important void in the evidence base is whether there are gendered differences in P4P uptake and in related outcomes amenable to healthcare improvement. This study assesses the gender-specific effects of P4P among family physicians on diabetes healthcare costs in a context of universal health coverage.MethodsWe use population-based linked longitudinal administrative datasets on chronic disease cases, physician billings, hospital discharge abstracts, and physician and resident registries in the province of New Brunswick, Canada. We estimate the effects of introduction of a P4P scheme on excess public healthcare costs among cohorts of adult diabetes patients using propensity score-adjusted difference-in-differences regressions stratified by physician’s gender.ResultsWe observed greater male physician uptake of incentive payments, seemingly exacerbating gender gaps in professional remuneration. Regression results indicated P4P did not lead to improved outcomes in terms of preventing hospitalization costs among patients, only measurable increases in compensation for both the male and female physician workforce.ConclusionsWhile P4P was not attributed in this study to reduced hospital burden and enhanced sustainability of healthcare financing, incentive payments were found to be related to earning gaps by physician’s gender. Decision-makers should consider that benefits of P4P be monitored not only for patient metrics but also for provider metrics in terms of gender equality especially given feminization of primary care medical workforces.

M-Health in the Surgical Context: Prospecting, Review and Analysis of Mobile Applications

Background m-Health initiatives can show an opportunity to improve the identification, prevention and management of certain diseases. Most health-care applications aims at chronic noncommunicable diseases care, and it is necessary to seek evidence from applications intended for surgical patient care, either before, during or after hospitalization. Objective: The Study Aims to identify and analyze, from the literature review and prospecting, applications for smartphones developed to assist the surgical patient. Methods: A descriptive-exploratory study developed in two sequential phases. The first one corresponded to an integrative review of the literature in the databases PubMed, Web of Knowledge, Europe PMC database and Cumulative Index to Nursing and Allied Health Literature database. The second phase corresponded to an exploration of applications in the European Patent Office, United States Patent and Trademark Office (USPTO), Free Patents Online, Canadian Intellectual Property Office and World Intellectual Property Organization. In both phases, we do not restrict the results by year of publication/registration or language. At each stage, the selected studies/patents were analyzed and pre-selected, according to the inclusion and exclusion criteria, by reading their titles and abstracts. Subsequently, we analyzed those with the potential of participation in the study, evaluating the answer to the research question, as well as the type of research, objectives, sample, method, outcomes, results and conclusion. Finally, the articles/patents record found were read in full. Results In the databases, 14 studies that presented some application for smartphone aimed at the surgical patient were selected. Most of them were in PubMed (64.3%), published in English (100%). Regarding origin, 28.6% of the texts are from the United States of America, 14.3 from Sweden and 14.3 from Canada. On the other hand, in patent databases, 10 registries were selected, 60% in the USPTO patent base, hosted in hybrid systems (iPhone and Android) and developed in the last 5 years (2014-1018) (80%). In general, there is a series of applications aimed at surgical patients, such as targets and/or users, mainly focused on the exchange of text and image messages but concentrated on assisting the physician/health team in the preparation of the patient during the procedure or post discharge. It is necessary to invest in the creation of technologies that aim to monitor these patients, especially in post discharge. Conclusion The characteristics of applications indicate a strong hospital centered tendency in relation to its purpose, having the surgeon as the main user and the surgical patient as the main target. The applications are still focused on optimizing diagnostics or functions, and no initiatives are identified to monitor the patient in a non-hospital environment.

Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi.

In Sub-Saharan Africa (SSA) the disease burden of chronic non-communicable diseases (CNCDs) is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP) payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy.

The primary healthcare centres

The central attributes of primary care are: first contact (accessibility), longitudinality (person- focused preventive and curative care overtime), patient-oriented comprehensiveness and coordination (including navigation towards secondary and tertiary care). Besides taking care of the needs of the individuals, primary health care teams are also looking at the community, especially when addressing social determinants of health. The rationale for the benefits for primary care for health has been found in: 1) greater access to needed services; 2) better quality of care; 3) a greater focus on prevention; 4) early management of health problems; 5) organizing and delivering high quality care for chronic non-communicable diseases. This paper describes the role of primary healthcare centres in strengthening community primary services and in reducing health inequalities. Furthemore, the experiences of Regional Health Services from Tuscany and Emilia-Romagna are discussed, with a brief overview of the literature.