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Models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis

Management of chronic conditions is a challenge for healthcare delivery systems world over and especially for low/middle-income countries (LMIC). Redesigning primary care to deliver quality care for chronic conditions is a need of the hour. However, much of the literature is from the experience of h...

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Autores principales: Lall, Dorothy, Engel, Nora, Devadasan, Narayanan, Horstman, Klasien, Criel, Bart
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326308/
https://www.ncbi.nlm.nih.gov/pubmed/30687524
http://dx.doi.org/10.1136/bmjgh-2018-001077
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author Lall, Dorothy
Engel, Nora
Devadasan, Narayanan
Horstman, Klasien
Criel, Bart
author_facet Lall, Dorothy
Engel, Nora
Devadasan, Narayanan
Horstman, Klasien
Criel, Bart
author_sort Lall, Dorothy
collection PubMed
description Management of chronic conditions is a challenge for healthcare delivery systems world over and especially for low/middle-income countries (LMIC). Redesigning primary care to deliver quality care for chronic conditions is a need of the hour. However, much of the literature is from the experience of high-income countries. We conducted a synthesis of qualitative findings regarding care for chronic conditions at primary care facilities in LMICs. The themes identified were used to adapt the existing chronic care model (CCM) for application in an LMIC using the ‘best fit’ framework synthesis methodology. Primary qualitative research studies were systematically searched and coded using themes of the CCM. The results that could not be coded were thematically analysed to generate themes to enrich the model. Search strategy keywords were: primary health care, diabetes mellitus type 2, hypertension, chronic disease, developing countries, low, middle-income countries and LMIC country names as classified by the World Bank. The search yielded 404 articles, 338 were excluded after reviewing abstracts. Further, 42 articles were excluded based on criteria. Twenty-four studies were included for analysis. All themes of the CCM, identified a priori, were represented in primary studies. Four additional themes for the model were identified: a focus on the quality of communication between health professionals and patients, availability of essential medicines, diagnostics and trained personnel at decentralised levels of healthcare, and mechanisms for coordination between healthcare providers. We recommend including these in the CCM to make it relevant for application in an LMIC.
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spelling pubmed-63263082019-01-25 Models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis Lall, Dorothy Engel, Nora Devadasan, Narayanan Horstman, Klasien Criel, Bart BMJ Glob Health Research Management of chronic conditions is a challenge for healthcare delivery systems world over and especially for low/middle-income countries (LMIC). Redesigning primary care to deliver quality care for chronic conditions is a need of the hour. However, much of the literature is from the experience of high-income countries. We conducted a synthesis of qualitative findings regarding care for chronic conditions at primary care facilities in LMICs. The themes identified were used to adapt the existing chronic care model (CCM) for application in an LMIC using the ‘best fit’ framework synthesis methodology. Primary qualitative research studies were systematically searched and coded using themes of the CCM. The results that could not be coded were thematically analysed to generate themes to enrich the model. Search strategy keywords were: primary health care, diabetes mellitus type 2, hypertension, chronic disease, developing countries, low, middle-income countries and LMIC country names as classified by the World Bank. The search yielded 404 articles, 338 were excluded after reviewing abstracts. Further, 42 articles were excluded based on criteria. Twenty-four studies were included for analysis. All themes of the CCM, identified a priori, were represented in primary studies. Four additional themes for the model were identified: a focus on the quality of communication between health professionals and patients, availability of essential medicines, diagnostics and trained personnel at decentralised levels of healthcare, and mechanisms for coordination between healthcare providers. We recommend including these in the CCM to make it relevant for application in an LMIC. BMJ Publishing Group 2018-12-30 /pmc/articles/PMC6326308/ /pubmed/30687524 http://dx.doi.org/10.1136/bmjgh-2018-001077 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0
spellingShingle Research
Lall, Dorothy
Engel, Nora
Devadasan, Narayanan
Horstman, Klasien
Criel, Bart
Models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis
title Models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis
title_full Models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis
title_fullStr Models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis
title_full_unstemmed Models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis
title_short Models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis
title_sort models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326308/
https://www.ncbi.nlm.nih.gov/pubmed/30687524
http://dx.doi.org/10.1136/bmjgh-2018-001077
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