Noncommunicable Diseases In Primary Care Research Articles

Physician factors affecting patient preferences in selecting a primary care provider: A qualitative research study in Singapore.

Care continuity by a dedicated, well-trained primary care physician (PCP) has shown to improve health outcomes of patients with non-communicable diseases (NCDs). In Singapore's fee-for-service primary care system, patients can choose to consult any PCP in either a public (polyclinic), private (General Practitioners/ GP), or both types of clinics, resulting in potential fragmented care. Decision-making by patients in selecting their preferred PCP remains unclear. This study aims to explore the personal factors influencing the choice of PCP among patients with NCDs in primary care. This qualitative research study was conducted in a typical polyclinic. In-depth interviews were conducted on patients with NCDs. Purposive sampling was implemented to enrol patients who had previously consulted PCPs in polyclinics and GP clinics, garnering their perspectives and experiences of care received from both providers. Interviews were audio-recorded, transcribed, and audited. Data was coded and analysed using thematic content analysis to identify emerging themes. The physician-specific factors which influence patients' decision-making of PCP selection are presented here. Twenty-one Asian patients aged 38 to 82 years were interviewed. They preferred PCPs with an approachable and genuine demeanour, exhibiting empathy and compassion. They valued the PCPs' verbal, non-verbal and listening skills. Regarding professional qualities, patients wanted PCPs to demonstrate competency and a patient-centred care approach. Some selected their PCP based on compatible age and gender that they felt comfortable with. Establishing good rapport with their PCP and maintaining continuity of care were deemed as major factors in patients' PCP selection. Patients tended to select PCPs based on their personal characteristics, interpersonal skills, professional attributes, demographics, and the physician-patient relationship. PCPs should be aware of these attributes and demonstrate them during their patient interaction. Leveraging on this enables PCPs to build rapport with their patients and maintain care continuity to optimize their health outcomes.

Utilization of Injectable Drugs for Communicable and Non-communicable Diseases in Primary Healthcare: A Retrospective Study in Turkey

Objective: Primary care, which is often the first level of contact for patients with various communicable diseases (CDs) and noncommunicable diseases (NCDs), might exhibit patterns of injectable drug utilization different from hospitals. We aimed to examine injection prescribing to adults with CD or NCD in primary care. Methods: In this retrospective study, single-diagnosis injectable drug-containing prescription data from Family Medicine Information System comprising 32 provinces of Turkey were analysed. The prescriptions were grouped by diagnosis as “CD” (n=3848) and “NCD” (n=9338). Injectable drug utilization patterns in these groups were analysed by demographics, diagnoses, and drug subgroups. Results: Out of 13186 prescriptions, 70.8% were issued for NCDs. NCD prescriptions were mostly generated for women and elderly (p<0.05 for both). About 63.3% (n=2948) of injectable drugs in CD prescriptions were antibiotics and 12.6% were analgesics. Cefazolin (15.2%) was the most commonly prescribed antibiotic for acute pharyngitis and acute sinusitis, and benzathine benzylpenicillin (12.8%) was the top-choice for acute tonsillitis and rheumatic fever. In NCD prescriptions, 34.0% (n=4214) of injectable agents were analgesics and 16.9% were muscle relaxants. The most frequently encountered drug in NCD prescriptions was thiocolchicoside (16.3%), which was the top-choice in all seven common musculoskeletal diagnoses. Conclusion: Muscle relaxants and analgesics were the most commonly prescribed injectable drugs for NCDs, musculoskeletal diseases in particular. Antibiotics were frequently encountered in CD prescriptions, mostly as broad-spectrum for lower respiratory tract infections (RTIs) and narrow-spectrum for upper RTIs. These findings may elucidate the issues to especially focus on regarding excessive use of injections.

Usability of Telehealth Systems for Noncommunicable Diseases in Primary Care From the COVID-19 Pandemic Onward: Systematic Review.

During the COVID-19 pandemic, telehealth was expanded without the opportunity to extensively evaluate the adopted technology's usability. We aimed to synthesize evidence on health professionals' perceptions regarding the usability of telehealth systems in the primary care of individuals with noncommunicable diseases (NCDs; hypertension and diabetes) from the COVID-19 pandemic onward. A systematic review was performed of clinical trials, prospective cohort studies, retrospective observational studies, and studies that used qualitative data collection and analysis methods published in English, Spanish, and Portuguese from March 2020 onward. The databases queried were MEDLINE, Embase, BIREME, IEEE Xplore, BVS, Google Scholar, and grey literature. Studies involving health professionals who used telehealth systems in primary care and managed patients with NCDs from the COVID-19 pandemic onward were considered eligible. Titles, abstracts, and full texts were reviewed. Data were extracted to provide a narrative qualitative evidence synthesis of the included articles. The risk of bias and methodological quality of the included studies were analyzed. The primary outcome was the usability of telehealth systems, while the secondary outcomes were satisfaction and the contexts in which the telehealth system was used. We included 11 of 417 retrieved studies, which had data from 248 health care professionals. These health care professionals were mostly doctors and nurses with prior experience in telehealth in high- and middle-income countries. Overall, 9 studies (82%) were qualitative studies and 2 (18%) were quasiexperimental or multisite trial studies. Moreover, 7 studies (64%) addressed diabetes, 1 (9%) addressed diabetes and hypertension, and 3 (27%) addressed chronic diseases. Most studies used a survey to assess usability. With a moderate confidence level, we concluded that health professionals considered the usability of telehealth systems to be good and felt comfortable and satisfied. Patients felt satisfied using telehealth. The most important predictor for using digital health technologies was ease of use. The main barriers were technological challenges, connectivity issues, low computer literacy, inability to perform complete physical examination, and lack of training. Although the usability of telehealth systems was considered good, there is a need for research that investigates factors that may influence the perceptions of telehealth usability, such as differences between private and public services; differences in the level of experience of professionals, including professional experience and experience with digital tools; and differences in gender, age groups, occupations, and settings. The COVID-19 pandemic has generated incredible demand for virtual care. Professionals' favorable perceptions of the usability of telehealth indicate that it can facilitate access to quality care. Although there are still challenges to telehealth, more than infrastructure challenges, the most reported challenges were related to empowering people for digital health. PROSPERO International Prospective Register of Systematic Reviews CRD42021296887; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=296887. RR2-10.21801/ppcrj.2022.82.6.

Comprehensive patient education and counselling for non-communicable diseases in primary care, Western Cape.

Treatment of non-communicable diseases (NCD) requires patient education and counselling (PEC). Initiatives have focused on Group Empowerment and Training (GREAT) for diabetes and Brief behaviour change counselling (BBCC). However, the implementation of comprehensive PEC in primary care remains a challenge. The aim of this study was to explore how such PEC could be implemented. This was a descriptive, exploratory, qualitative study at the end of the first year of a participatory action research project to implement comprehensive PEC for NCDs at two primary care facilities in the Western Cape. Focus group interviews were held with healthcare workers and reports from co-operative inquiry group meetings were used as qualitative data. Staff were trained in GREAT for diabetes and BBCC. There were problems with training appropriate staff and sufficient numbers and a need for ongoing support. Implementation was limited by poor internal sharing of information, staff turnover and leave, rotation of staff, lack of space and fears of disrupting the efficiency of service delivery. Facilities had to embed the initiatives into appointment systems and fast track patients who attended GREAT. For those patients that were exposed to PEC, there were reported benefits. Group empowerment was feasible to introduce, while BBCC was more challenging as it required extra time in the consultation.Contribution:Implementation of PEC requires alternative approaches that do not extend consultations (such as GREAT and maybe digital solutions) as well as commitment to facility organisation for PEC from managers.

New coronavirus infection in patients with chronic non-communicable diseases in primary care

BACKGROUND: The pandemic of a new coronavirus infection, which began in the Chinese city of Wuhan in December 2019, has spread to more than 200 countries and territories. There are a number of studies, the results of which indicate that deaths are mainly registered among the middle-aged and elderly population with chronic non-communicable diseases. Most of these studies are based on the study of cases of COVID-19 with severe course or in hospitalized patients. At the same time, a greater number of patients, including those with chronic non-communicable diseases, carry COVID-19 to a mild degree and remain under the supervision of primary care physicians.
 AIM: To identify risk factors for the development of severe COVID-19 in patients with chronic non-communicable diseases who sought outpatient care during various periods of increased incidence of new coronavirus infection from March 2020 to February 2022.
 MATERIALS AND METHODS: The study was carried out on the basis of the Family Medicine Center of North-Western State Medical University named after I.I. Mechnikov, which provides primary health care to the population attached under compulsory health insurance. The design of the study was published earlier. A retrospective cohort study was conducted based on the analysis of outpatient records of patients who sought medical care at the Family Medicine Center during various periods of increased incidence of COVID-19: from 19.03.2020 to 30.06.2020 (group 1), from 1.10.2021 to 30.11.2021 (group 2) and from 18.01.2022 to 28.02.2022 (group 3).
 RESULTS: 343 patients were included in the study: 137 men (39.9%) and 206 women (60.1%). The number of patients with at least one chronic non-communicable disease was 232 (67.9%). It was found that the severity of COVID-19 is not affected by the presence of one or more chronic non-communicable diseases of mild severity in the patient. At the same time, grade II obesity and grade III hypertension are independent factors that significantly increase the risk of developing severe COVID-19 by 13.4 and 5.4 times, respectively (p 0.05). It should be noted that the combination of these diseases significantly increased the likelihood of developing severe COVID-19 by 11.9 times (p 0.05).
 CONCLUSIONS: Regardless of the period of morbidity, the clinical manifestations of COVID-19 in patients with chronic non-communicable diseases have their own characteristics: weakness, sweating, dry and wet cough are significantly more common (p 0.05). With each subsequent wave of increase in the incidence of COVID-19 in patients with chronic non-communicable diseases, there is a significant tendency to decrease the frequency of severe and very severe course of the disease, pneumonia and hospitalization, as in patients without chronic non-communicable diseases. It was found that the severity of the COVID-19 course is not affected by the presence of mild chronic non-communicable diseases in the patient. At the same time, grade II and higher obesity or grade III hypertension are independent factors that significantly increase the risk of developing severe COVID-19 by 11.9 and 5.4 times, respectively (p 0.05). The combination of these diseases significantly increased the probability of developing severe COVID-19 by 13.4 times (p 0.05).

MHealth guideline training for non-communicable diseases in primary care facilities in Nigeria: a mixed methods pilot study

ObjectiveTo pilot the use of a scalable innovative mobile health (mHealth) non-communicable diseases (NCDs) training application for nurses at the primary care level.DesignMixed methods pilot of mHealth training on NCD...

Strengthening management of non-communicable diseases in primary care, Malawi: A short report.

Within the community-orientated primary care module for training family physicians at the Kamuzu University of Health Sciences in Malawi, a relationship was formed between Nkhoma Mission Hospital’s Family Medicine Department and the Diamphwe Community Health Centre (HC) to strengthen the continuity of healthcare and capacity team building. The initial focus was on improving the management of hypertension and diabetes in terms of diagnosis, tracking of the patients in a registry and timely referral to secondary care facilities The relationship has received positive support from Diamphwe healthcare workers, which then improved the management of non-communicable diseases and patient care at Diamphwe. It has also shown how family medicine physicians can improve HC capacity through support and mentorship.

Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS)

BackgroundThe monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18).MethodsNNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) – Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises.ResultsTotal of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3–3.3) in rural public to 9.0% (95% CI; 6.2–13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities.ConclusionBoth private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.

Capacity building of health care professionals to perform interprofessional management of non-communicable diseases in primary care \u2013 experiences from Ukraine

BackgroundNon-communicable diseases are leading causes of death and disability across the world. Countries with the highest non-communicable disease (NCD) burden in the WHO European Region are often those that have some of the greatest health system challenges for achieving good outcomes in prevention and care. The aim of this study was to evaluate the effect of an interprofessional capacity building intervention carried out in Ukraine to improve the management non-communicable diseases in primary health care.MethodsA mixed-methods evaluation study was performed in 2018 to analyse the effect of a capacity building intervention carried out for over 10,000 primary care professionals in Ukraine in 2018. Quantitative data were collected from primary health care records of intervention and control areas preceding the intervention and 1.5 to 2 years after the intervention. Altogether 2798 patient records before and 2795 after the intervention were reviewed. In control areas, 1202 patient records were reviewed. Qualitative data were collected carrying out focus group interviews for health professionals, clinic managers and patients. Also, observations of clinical practice and patient pathways were performed.ResultsThe capacity building intervention improved the capacity of professionals in detection and management of non-communicable disease risk factors. Significant improvement was seen in detection rates of both behavioural and biological risk factors and in medication prescription rates in the intervention areas. However, almost similar improvement in prescription rates was also observed in control clinics. Improvements in control of blood pressure, blood glucose and cholesterol were not seen during the evaluated implementation period. Qualitative analyses highlighted the improved knowledge and skills but challenges in changing the current practice.ConclusionsA large scale capacity building intervention improved primary health care professionals’ knowledge, skills and clinical practice on NCD risk detection and reduction. We were not able to detect improvements in treatment outcomes - at least within 1.5 to 2 years follow-up. Improvement of treatment outcomes would most likely need more comprehensive systems change.

Addressing social determinants of noncommunicable diseases in primary care: a scoping review

Abstract Background Noncommunicable diseases (NCDs) are the leading cause of global mortality, and their risk factors largely manifest at the community level. In collaboration with public health, primary care is well placed to assess and address the local social determinants of NCDs (SDONCDs). Post-Astana, many countries are reorienting their primary care systems to incorporate these traditional public health functions, but there is little evidence to guide reform. We aimed to collate examples of primary care organisations that already engage in this activity. Methods Following Cochrane guidance, PubMed, MEDLINE, Embase & HMIC were searched from inception to 28/7/2019, along with hand-searching of references for any study designs that examined international primary care organisation(s) that addressed local SDONCDs. Independent dual review was used for screening, data extraction, and quality assessment - for which we used ROBINS-i. Results Searches identified 666 studies of which 17 studies from Canada, South Africa, UK, and USA were included. All used descriptive study designs. Individual-level surveys and interviews were the most common SDONCD data collection methods reported. Fewer studies collated population-level data held by external agencies. Actions ranged from individual-level interventions to novel representation of primary care organisations on system-level policy and planning committees. Several enablers and barriers to collecting and mobilising social determinant data within well- and under-resourced primary care settings were identified. Conclusions Several models of integrated public health and primary care already exist that fulfil the Astana mandate of developing place-based preventive services, tailored to local needs. Public health input at this granular level is required to support primary care services as they extend their scope of practice, and to assist with monitoring and evaluation of new initiatives to mitigate unmet health and social needs. Key messages Primary care organisations are increasingly being encouraged to assess and address local social determinants of noncommunicable diseases but there is weak evidence to guide reform. The different approaches described in our review can help policymakers tasked with integrating public health functions into primary care.

Addressing social determinants of noncommunicable diseases in primary care: a systematic review.

ObjectiveTo explore how primary care organizations assess and subsequently act upon the social determinants of noncommunicable diseases in their local populations.MethodsFor this systematic review we searched the online databases of PubMed®, MEDLINE®, Embase® and the Health Management Information Consortium from inception to 28 June 2019, along with hand-searching of references. Studies of any design that examined a primary care organization assessing social determinants of noncommunicable diseases were included. For quality assessment we used Cochrane’s tool for assessing risk of bias in non-randomized studies of interventions. We used narrative data synthesis to appraise the extent to which the assessments gathered data on the domains of the World Health Organization social determinants of health framework.FindingsWe identified 666 studies of which 17 were included in the review. All studies used descriptive study designs. Clinic-based and household surveys and interviews were more commonly used to assess local social determinants than population-level data. We found no examples of organizations that assessed sociopolitical drivers of noncommunicable diseases; all focused on sociodemographic factors or circumstances of daily living. Nevertheless, the resulting actions to address social determinants ranged from individual-level interventions to population-wide measures and introducing representation of primary care organizations on system-level policy and planning committees.ConclusionOur findings may help policy-makers to consider suitable approaches for assessing and addressing social determinants of health in their domestic context. More rigorous observational and experimental evidence is needed to ascertain whether measuring social determinants leads to interventions which mitigate unmet social needs and reduce health disparities.

Addressing noncommunicable diseases in primary care: the case of type 2 diabetes.

The rapid growth of noncommunicable diseases represents a formidable global health challenge. Here we use type 2 diabetes as a case study to illustrate the rise of noncommunicable diseases and call attention to the important role of primary care systems in addressing these diseases in low- and middle-income countries. Comprehensive screening for diabetes should be implemented through primary care systems to increase early detection of prediabetes and undiagnosed diabetes - a first step to diabetes prevention and management. In addition, primary care systems should strengthen and expand capacity to link patients to appropriate interventions based on their diabetes status and provide care coordination (e.g. leveraging task-shifting and technology), and integrate clinic and community resources for diabetes prevention and control. Additional strategies should include continuous quality improvement, health systems strengthening, workforce development, and affordable and sustainable financing. Together, these actions could elevate the role of primary care in addressing diabetes in low- and middle-income countries and help advance global progress towards reducing diabetes complications, and also preventing or delaying diabetes among those at risk.

HIV with non-communicable diseases in primary care in Kibera, Nairobi, Kenya: characteristics and outcomes 2010-2013.

Antiretroviral therapy (ART) has increased the life expectancy of people living with HIV (PLHIV); HIV is now considered a chronic disease. Non-communicable diseases (NCDs) and HIV care were integrated into primary care clinics operated within the informal settlement of Kibera, Nairobi, Kenya. We describe early cohort outcomes among PLHIV and HIV-negative patients, both of whom had NCDs. A retrospective analysis was performed of routinely collected clinic data from January 2010 to June 2013. All patients >14 years with hypertension and/or diabetes were included. Of 2206 patients included in the analysis, 210 (9.5%) were PLHIV. Median age at enrollment in the NCD program was 43 years for PLHIV and 49 years for HIV-negative patients (p<0.0001). The median duration of follow up was 1.4 (IQR 0.7-2.1) and 1.0 (IQR 0.4-1.8) years for PLHIV and HIV-negative patients, respectively (p=0.003). Among patients with hypertension, blood pressure outcomes were similar, and for those with diabetes, outcomes for HbA1c, fasting glucose and cholesterol were not significantly different between the two groups. The frequency of chronic kidney disease (CKD) was 12% overall. Median age for PLHIV and CKD was 50 vs 55 years for those without HIV (p=0.005). In this early comparison of PLHIV and HIV-negative patients with NCDs, there were significant differences in age at diagnosis but both groups responded similarly to treatment. This study suggests that integrating NCD care for PLHIV along with HIV-negative patients is feasible and achieves similar results.