Access to hypertension care and services in primary health-care settings in Vietnam: a systematic narrative review of existing literature

Abstract

Background : Health care in Vietnam is challenged by a high burden of hypertension (HTN). Since 2000, several interventions were implemented to manage HTN; it is not clear what is the status of patient access to HTN care. Objective : This article aims to perform a systematic narrative review of the available evidence on access to HTN care and services in primary health-care settings in Vietnam. Methods : Search engines were used to identify relevant records of scientific and grey literature. Data from selected articles were analysed using standardised spreadsheets and MaxQDA and following a framework synthesis methodology. Results : There has been increasing interest in research and policy concerning the burden of HTN in Vietnam, covering many aspects of access to treatment at the primary health-care level. Vietnam’s National HTN Programme is managed as a vertical programme and its services integrated into the network of primary health-care facilities across the public sector in selected provinces. The Programme financed population-wide screening campaigns for the early detection of HTN among people above 40 years of age. There was no information on the acceptability of HTN health services, especially regarding the interaction between patients and health professionals. In general, articles reported good availability of medication, but problems in accessing them included: fragmentation and lack of consistency in prescribing medication between different levels and short timespans for dispensing medication at primary health-care facilities. There was limited information related to the cost and economic impact of HTN treatment. Treatment adherence among hypertensive patients based on four studies did not exceed 70%. Conclusions : Although the Vietnamese health-care system has taken steps to accommodate some of the needs of HTN patients, it is crucial to scale-up interventions that allow for regular, systematic, and integrated care, especially at the lowest levels of care.

Improving Efficiency in the Health Sector

“…Third, from a theoretical perspective, as outlined in the earlier section, integration is important for NCD care because many NCDs are chronic conditions that require consistent follow-up to manage the disease, and care is often more appropriate and cheaper when delivered close to the patient, in the community. A lack of integration across providers-including discontinuity in medical information and the treatment process between levels and even from one treatment episode to another, and a lack of organized two-way referral-has already been identified as a gap in NCD management (Meiqari et al 2019). This study aims to dig deeper and provide more detail on the components and organizational processes of care integration.…”

Strengthening human and physical infrastructure of primary healthcare settings to deliver hypertension care in Vietnam: a mixed-methods comparison of two provinces

“…In Vietnam, the overall prevalence of HTN was 21% and subjects with HTN had low estimates for the prevalence of HTN awareness (43%) and treatment (33%); these three estimates were significantly lower in rural areas. A few studies showed limited accommodation for HTN medications at commune health stations (CHSs), which are the entry point of care to the health system ( Van Huy et al , 2018 ; Duong et al , 2019 ; Meiqari et al , 2019b ). In 2008, the Ministry of Health established the National HTN programme, which piloted a model for HTN management at the grassroots level ( Nguyen et al , 2011 ; 2012 ; Lim et al , 2014 ; Meiqari et al , 2019b ); although this model was scaled-up gradually, activities for HTN were implemented in less than half of the CHSs by 2014 ( Meiqari et al , 2019b ).…”

“…A few studies showed limited accommodation for HTN medications at commune health stations (CHSs), which are the entry point of care to the health system ( Van Huy et al , 2018 ; Duong et al , 2019 ; Meiqari et al , 2019b ). In 2008, the Ministry of Health established the National HTN programme, which piloted a model for HTN management at the grassroots level ( Nguyen et al , 2011 ; 2012 ; Lim et al , 2014 ; Meiqari et al , 2019b ); although this model was scaled-up gradually, activities for HTN were implemented in less than half of the CHSs by 2014 ( Meiqari et al , 2019b ). In general, the establishment of disease- or service-specific vertical programmes has helped to provide rapid results in weak health systems and to establish better accountability and transparent governance, especially towards international organizations and funders ( Atun et al , 2008 ).…”

“…In addition, there is scarce evidence regarding the provision of HTN care in Vietnam. We performed a systematic narrative review about the available evidence on access to HTN care and services in PHC settings in Vietnam ( Meiqari et al , 2019b ), based on the framework on people-centred access to health care ( Levesque et al , 2013 ). The framework described access as a multidimensional concept resulting from the interaction between five dimensions of accessibility for the health system, which supplies care (namely, approachability, acceptability, availability and accommodation, affordability and appropriateness) and five corresponding abilities of populations who demand care (namely, ability to perceive, to seek, to reach, to pay and to engage).…”

“…For example, Thừa Thiên-Huế (Hue) province in Central Vietnam received international support through investments in the infrastructure of CHSs and the development of a family medicine programme, which allowed Hue’s Provincial Department of Health to deploy a family medicine doctor in most CHSs ( Proscio, 2011 ; Hoang, 2018 ). Also, Hue maintained the operation of the ‘District Health Centre’ where the District Hospital (DH) is responsible for managing curative and preventive care at the district level, while Thai Nguyen has separated entities for ‘DH’ and ‘District Preventive Medicine Centre’ that are operating independently ( Meiqari et al , 2019b ). This research aimed to describe, qualitatively and quantitatively, the delivery and organization of HTN care at PHC settings in both urban and rural areas at Hue in comparison with another province (Thai Nguyen) based on the infrastructure capacity and patients’ and providers’ perspectives and experiences.…”