Innovative Care For Chronic Conditions Research Articles

Perspectives of healthcare providers and persons with type 2 diabetes mellitus on improving glycaemic control in Kinshasa, Democratic Republic of the Congo: a qualitative study

IntroductionGlycaemic control remains suboptimal in the Democratic Republic of the Congo. Defining interventions to improve glycaemic control requires a clear knowledge of factors driving poor glycaemic control. Qualitative studies exploring...

Towards integrated mental health services in low-income and middle-income countries: organisation of primary healthcare providers – a scoping review protocol

IntroductionMental health conditions constitute a significant percentage of the global burden of disease. A shortfall of mental health specialists and a lack of integration of services in primary care in...

Diabetes care components effectively implemented in the ASEAN health systems: an umbrella review of systematic reviews

ObjectivesAssociation of Southeast Asian Nations (ASEAN) is among the hardest hit low-income and middle-income countries by diabetes. Innovative Care for Chronic Conditions (ICCC) framework has been adopted by the WHO...

National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke: A Scoping Review in the Context of Hypertension Prevention and Control in India.

A scoping review was carried out to identify gaps in the performance of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) towards the preparedness of the public health system especially at primary level in dealing with hypertension (HTN). The World Health Organization Innovative Care for Chronic Conditions (WHO ICCC) framework was adapted for the current review under three levels namely micro, meso, and macro. PubMed Central was accessed to retrieve eligible articles published since 2010. Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist was followed for reporting. A final selection of 27 articles that fulfilled the eligibility criteria of the current review was drawn from a long list of 542 articles. Cross-sectional studies contributed to 51.8% of the included studies. We observed that NPCDCS had gaps across all levels of health care, especially at the primary level. At the micro-level noncommunicable diseases (NCDs), awareness among patients was suboptimal and treatment adherence was poor. At the meso-level, there was a vacancy in all cadres of workers and lack of regular training of workforce, laboratory services, and inconsistent availability of essential drugs, equipment, and related supplies to be ensured. At the macro-level, public spending on NCD care needs to be increased along with strategies to reduce out-of-pocket expenditure and improve universal health coverage. In conclusion, there is a need to improve components related to all three levels of the WHO ICCC framework to amplify the impact of HTN care through NPCDCS, particularly at the primary level.

Improving care for cancer-related and other forms of lymphoedema in low- and middle-income countries: a qualitative study

BackgroundLymphoedema is a common, distressing and debilitating condition that can be related to cancer and its treatment or other conditions. Little is known about current practices in the diagnosis, assessment and management of lymphoedema in low- and middle-income countries (LMIC).AimTo describe current practices in diagnosing, assessing and managing cancer-related and other forms of lymphoedema in LMIC, and related barriers and facilitators.MethodsAn exploratory-descriptive qualitative study. Participants were lymphoedema experts or health care professionals identified via published lymphoedema papers and professional organizations respectively. Sampling was purposive to ensure a diversity of perspectives and experience. Data collection was via semi-structured telephone/video interviews, and questions canvassed participants’ experiences and perceptions of lymphoedema care in LMIC. Interviews were audio-recorded and transcribed verbatim. Analysis proceeded via inductive coding before mapping codes to the World Health Organization’s (WHO) Innovative Care for Chronic Conditions Framework.ResultsNineteen participants were interviewed, most of whom were physiotherapists (n = 11). Ten participants worked permanently in a LMIC, while the remainder were based in a high-income country (HIC) and had been involved in initiatives to improve lymphoedema care across multiple LMIC. Participants indicated that management of cancer versus non-cancer related lymphoedema was similar, but that pathways to care were more straight-forward for those receiving cancer care, leading to earlier diagnosis. Key facilitators to optimizing lymphoedema care in LMIC included: 1) joining forces to overcome lymphoedema-related stigma; 2) building workforce capabilities; and 3) partnering with patients and families to support self-management. Ideas for building workforce included developing health professional knowledge, supporting a commitment to multidisciplinary team care, and adapting HIC guidelines for lymphoedema care to LMIC. Partnering with patients and families to support self-management involved following the person-centred approach, establishing clear communication, promoting adherence to management, adapting management to available resources, and involving patient family and friends in lymphoedema care.ConclusionRaising community and health professional awareness regarding lymphoedema and its management is a key first step to improving care outcomes. Resources for clinicians and patients/families developed for lymphoedema care in HIC need to be adapted for low resource settings.

EDITORIAL: MORBIDITY MANAGEMENT AND DISABILITY PREVENTION: AN AGENDA FOR DEVELOPING NATIONS INITIATED IN INDIA

Treatment of patients with lymphedema focuses on reducing limb volume with more recent recognition of the importance of quality-of-life issues. Perhaps due to the incidence of filariasis-related lymphedema compared to breast cancer-related lymphedema in the western world, the Institute of Applied Dermatology (IAD) in Kerala, India has developed a low-cost and culturally acceptable treatment with quality-of-life focus that works well in that area. Worldwide, there is also recognition of chronic edema as a potential co-morbidity and the recent advances in genetic analysis continue to shed light on lymphedema development that may be important in filariasis-related lymphedema. Although improvement in treatment outcomes by surgical means has been shown, there is often conventional treatment mixed in the therapy and no randomized controls of any therapy exist. In addition, these techniques require supermicrosurgical skill not available in many areas of the world. The WHO has documented the need in filariasis for both universal health care and innovative care for chronic conditions. The IAD has addressed these issues with its integrative model of treatment with patient quality-of-life at the forefront to incorporate traditional practice to involve the patient more fully in family and community support for an additional therapeutic tool.

Values and principles of person-centered integrated care: a systematic literature review (SIG meeting)

Introduction: In recent years many knowledge about integrated health services has been developed. So far research has focused on operational themes and interventions on the one side, which help decision makers in practice. On the other hand, a number of studies about generic elements of person-centered and integrated care have been published, resulting in valuable conceptual models and frameworks [1-9]. A third area of research is how to measure integrated care. However, if we want to further develop the person-centered integrated approach to improve the quality of services for civilians, a better understanding of the essence of integrated care and it’s underlying values is necessary. Shared values and principles can help to concretely identify what integrated care really is about and what integrated care thinking stands for [10,11]. Therefore, IFIC and Vilans have initiated a Special Interest Group (SIG) on values and principles of integrated care. The aim of the SIG is to develop a valuable and workable set of values and principles for person-centered integrated care. Within this context, a systematic literature review on value and principles of person-centered integrated care is carried out as a starting point. We propose a session with two objectives: A SIG-meeting with exchange of experiences A presentation and discussion about the first deliverable: the systematic literature review Theory/Methods: A systematic literature review of scientific and grey literature was conducted. Two researchers independently screened the initial results by title and abstract. Differences in interpretation were resolved by consensus. Each full text paper was independently assessed by two researchers on the criteria for inclusion. In each included article, values and principles of person-centered integrated care were identified and coded independently by two researchers. The codes were discussed in the research team. 3) Preliminary results 732 records were identified through the systematic search. After removing duplicates 396 articles remained, of which 48 were assessed for eligibility after the screening of titles and abstracts. 23 articles (48%) contained values and principles of person-centered integrated care and were coded. Currently (Dec 2016) an expert panel, mostly members of IFIC and Vilans’ SIG on Values of Integrated Care, is reflecting on the search results. Additional articles suggested by experts, are being added to the database the coming months (before ICIC2017). The experts have a range of backgrounds, including health and social care, and practice and academia. Conclusion & Discussion: A large amount of literature about integrated care is available, but less about the underlying values and principles. Preliminary results show that in the selected articles values and principles are present, which partly support the set of Ferrer and Goodwin [12]. At this moment the international expert panel is reviewing the search results, more definite results can be discussed in spring nest year. Lessons learned: Only limited literature has a focus on this level of abstraction (values and principles). The perspective appears to be quite new which is interesting a SIG topic. Limitations: Because the limited amount of literature, available conceptual models were analysed to derive values and principles. The quality of this process asks for skilled researchers; to enhance quality, all articles were independently assessed by two researchers. Suggestions for future research: To further develop the set of values and principles, a multi-perspective Delphi Study will be carried out. Multiple (SIG) experts with different backgrounds (clients, caregivers, developers, researchers) will be involved. The results of the Delphi Study will also be shared in the SIG.

Perceptions on diabetes care provision among health providers in rural Tanzania: a qualitative study.

Diabetes prevalence in Tanzania was estimated at 9.1% in 2012 among adults aged 24–65 years — higher than the HIV prevalence in the general population at that time. Health systems in lower- and middle-income countries are not designed for chronic health care, yet the rising burden of non-communicable diseases such as diabetes demands chronic care services. To inform policies on diabetes care, we conducted a study on the health services in place to diagnose, treat and care for diabetes patients in rural Tanzania. The study was an exploratory and descriptive study involving qualitative methods (in-depth interviews, observations and document reviews) and was conducted in a rural district in Tanzania. Fifteen health providers in four health facilities at different levels of the health care system were interviewed. The health care organization elements of the Innovative Care for Chronic Conditions (ICCC) framework were used to guide assessment of the diabetes services in the district. We found that diabetes care in this district was centralized at the referral and district facilities, with unreliable supply of necessary commodities for diabetes care and health providers who had some knowledge of what was expected of them but felt ill-prepared for diabetes care. Facility and district level guidance was lacking and the continuity of care was broken within and between facilities. The HMIS could not produce reliable data on diabetes. Support for self-management to patients and their families was weak at all levels. In conclusion, the rural district we studied did not provide diabetes care close to the patients. Guidance on diabetes service provision and human resource management need strengthening and policies related to task-shifting need adjustment to improve quality of service provision for diabetes patients in rural settings.

'Restoring the person's life': a qualitative study to inform development of care for people with severe mental disorders in rural Ethiopia.

In low-income countries, care for people with severe mental disorders (SMDs) who manage to access treatment is usually emergency-based, intermittent or narrowly biomedical. The aim of this study was to inform development of a scalable district-level mental health care plan to meet the long-term care needs of people with SMD in rural Ethiopia. The present study was carried out as formative work for the Programme for Improving Mental health CarE which seeks to develop, implement and evaluate a district level model of integrating mental health care into primary care. Six focus group discussions and 25 in-depth interviews were conducted with service planners, primary care providers, traditional and religious healers, mental health service users, caregivers and community representatives. Framework analysis was used, with findings mapped onto the domains of the Innovative Care for Chronic Conditions (ICCC) framework. Three main themes were identified. (1) Focused on 'Restoring the person's life', including the need for interventions to address basic needs for food, shelter and livelihoods, as well as spiritual recovery and reintegration into society. All respondents considered this to be important, but service users gave particular emphasis to this aspect of care. (2) Engaging with families, addressed the essential role of families, their need for practical and emotional support, and the importance of equipping families to provide a therapeutic environment. (3) Delivering collaborative, long-term care, focused on enhancing accessibility to biomedical mental health care, utilising community-based health workers and volunteers as an untapped resource to support adherence and engagement with services, learning from experience of service models for chronic communicable diseases (HIV and tuberculosis) and integrating the role of traditional and religious healers alongside biomedical care. Biomedical approaches were more strongly endorsed by health workers, with traditional healers, religious leaders and service users more inclined to see medication as but one component of care. The salience of poverty to service planning was cross-cutting. Stakeholders prioritised interventions to meet basic needs for survival and endorsed a multi-faceted approach to promoting recovery from SMD, including social recovery. However, sole reliance on this over-stretched community to mobilise the necessary resources may not be feasible. An adapted form of the ICCC framework appeared highly applicable to planning an acceptable, feasible and sustainable model of care.

An overview of chronic disease models: a systematic literature review.

Aims:The objective of our study was to examine various existing chronic disease models, their elements and their role in the management of Diabetes, Chronic Obstructive Pulmonary Disease (COPD), and Cardiovascular diseases (CVD).Methods:A literature search was performed using PubMed and CINHAL during a period of January 2003- March 2011. Following key terms were used either in single or in combination such as “Chronic Disease Model” AND “Diabetes Mellitus” OR “COPD” OR ‘CVD”.Results:A total of 23 studies were included in the final analysis. Majority of the studies were US-based. Five chronic disease models included Chronic Care Model (CCM), Improving Chronic Illness Care (ICIC), and Innovative Care for Chronic Conditions (ICCC), Stanford Model (SM) and Community based Transition Model (CBTM). CCM was the most studied model. Elements studied included delivery system design and self-management support (87%), clinical information system and decision support (57%) and health system organization (52%). Elements including center care on the patient and family (13%), patient safety (4%), community policies (4%), built integrated health care (4%) and remote patient monitoring (4%) have not been well studied. Other elements including support paradigm shift, manage political environment, align sectoral policies for health, use healthcare personnel more effectively, support patients in their communities, emphasize prevention, identify patient specific concerns related to the transition process, and health literacy between visits and treatments have also not been well studied in the existing literature.Conclusions:It was unclear to what extent the results generated is applicable to different populations and locations and therefore is an area of future research. Future studies are also needed to test chronic disease models in settings where more racially and ethnically representative patients receive chronic care. Future program development should also include information on other barriers including transportation issues, finances and lack of services.

Chronic diseases and multi-morbidity--a conceptual modification to the WHO ICCC model for countries in health transition.

BackgroundThe burden of non-communicable diseases is rising, particularly in low and middle-income countries undergoing rapid epidemiological transition. In sub-Saharan Africa, this is occurring against a background of infectious chronic disease epidemics, particularly HIV and tuberculosis. Consequently, multi-morbidity, the co-existence of more than one chronic condition in one person, is increasing; in particular multimorbidity due to comorbid non-communicable and infectious chronic diseases (CNCICD). Such complex multimorbidity is a major challenge to existing models of healthcare delivery and there is a need to ensure integrated care across disease pathways and across primary and secondary care.DiscussionThe Innovative Care for Chronic Conditions (ICCC) Framework developed by the World Health Organization provides a health systems roadmap to meet the increasing needs of chronic disease care. This framework incorporates community, patient, healthcare and policy environment perspectives, and forms the cornerstone of South Africa’s primary health care re-engineering and strategic plan for chronic disease management integration. However, it does not significantly incorporate complexity associated with multimorbidity and CNCICD.Using South Africa as a case study for a country in transition, we identify gaps in the ICCC framework at the micro-, meso-, and macro-levels. We apply the lens of CNCICD and propose modification of the ICCC and the South African Integrated Chronic Disease Management plan. Our framework incorporates the increased complexity of treating CNCICD patients, and highlights the importance of biomedicine (biological interaction). We highlight the patient perspective using a patient experience model that proposes that treatment adherence, healthcare utilization, and health outcomes are influenced by the relationship between the workload that is delegated to patients by healthcare providers, and patients’ capacity to meet the demands of this workload. We link these issues to provider perspectives that interact with healthcare delivery and utilization.SummaryOur proposed modification to the ICCC Framework makes clear that healthcare systems must work to make sense of the complex collision between biological phenomena, clinical interpretation, beliefs and behaviours that follow from these. We emphasize the integration of these issues with the socio-economic environment to address issues of complexity, access and equity in the integrated management of chronic diseases previously considered in isolation.

A China-specified Multi-level Technical Infrastructure for Diabetes

This study uses the World Health Organization Innovative Care for Chronic Conditions (ICCC) framework to specify current diabetes prevention and management challenges in China as a basis for design of a technical architectural infrastructure to address gaps and leverage strengths using smart phone technologies as a core element. We acknowledge past theoretically grounded chronic care models as well as systematic literature review of the status of diabetes care in China. We expand the boundaries of pre-existing human and organizational capabilities in the area of diabetes management by creating new and innovative artifacts intended to: (1) help policy makers and technologists understand and contribute to a comprehensive infrastructure to address management of chronic conditions in China and (2) serve as an example of ICCC specification applied to a particular context to facilitate contextual understanding and innovation for healthcare technology development.

Health span or life span: The role of patient-reported outcomes in informing health policy

Population ageing and the increasing burden of chronic conditions challenge traditional metrics of assessing the efficacy of health care interventions and as a consequence policy and planning. Using chronic heart failure (CHF) as an exemplar this manuscript seeks to describe the importance of patient-reported outcomes to inform policy decisions. The method of an integrative review has been used to identify patient-reported outcomes (PROs) in assessing CHF outcomes. Using the Innovative Care for Chronic Conditions the case for developing a metric to incorporate PROs in policy planning, implementation and evaluation is made. In spite of the increasing use of PROs in assessing CHF outcomes, their incorporation in the policy domain is limited. Effective policy and planning is of health care services is dependent on the impact on the individual and their families. Epidemiological transitions and evolving treatment paradigms challenge traditional metrics of morbidity and mortality underscoring the importance of assessing PROs.

Care for chronic conditions for indigenous Australians: Key informants’ perspectives on policy

The WHO's 2002 global report, Innovative Care for Chronic Conditions proposes a comprehensive framework for health systems to meet the challenges posed by chronic conditions. This paper uses the policy environment component of the WHO framework as a lens through which to examine key informants' perspectives on the management and prevention of chronic conditions in rural and remote Aboriginal communities in Australia. Twenty one semi-structured telephone interviews were conducted with a purposive sample of stakeholders, including senior commonwealth, state/territory and regional public servants and health service staff. All of the interviews were audio recorded, from which written summaries were produced. These summaries were then content analysed to build a composite picture of this area. The results indicate substantial success in developing national and sub-national strategies and refining funding and reporting arrangements. But much work remains to be done in strengthening partnerships, developing and retaining the workforce, and further shifting the focus from acute to chronic conditions. This paper provides a snapshot of the main policy issues, as identified by key informants, facing chronic disease management in rural and remote Indigenous communities in Australia. It has the potential to contribute to new national policy directions in Indigenous health.

It takes a village to prevent falls: reconceptualizing fall prevention and management for older adults

Systematic evidence reviews support the efficacy of physical activity programs and multifactorial strategies for fall prevention. However, community settings in which fall prevention programs occur often differ substantially from the...

Improving the quality of health care for chronic conditions.

Chronic conditions are increasingly the primary concern of health care systems throughout the world. In response to this challenge, the World Health Organization has joined with the MacColl Institute for Healthcare Innovation to adapt the Chronic Care Model (CCM) from a global perspective. The resultant effort is the Innovative Care for Chronic Conditions (ICCC) framework which expands community and policy aspects of improving health care for chronic conditions and includes components at the micro (patient and family), meso (health care organisation and community), and macro (policy) levels. The framework provides a flexible but comprehensive base on which to build or redesign health systems in accordance with local resources and demands.