An international partnership to implement innovative systems of health care delivery for diabetes in a developing country

Abstract

Sri Lanka currently faces a ‘double burden’ of non‐communicable and communicable diseases. Public institutions geared primarily to care for communicable diseases struggled to meet demand for quality care in non‐communicable diseases. The World Health Organization has developed tools for implementing appropriate health care for long‐term problems.We piloted interventions in self‐management support, delivery system design, decision support and clinical information systems at sites in urban and rural Sri Lanka. This undertaking confirmed that interventions through adaptation of Sri Lanka's primary care infrastructure and establishment of innovative partnerships enable the effective implementation of care with existing resources in the short term. We demonstrated that media can be used as a powerful forum for educating the public, promoting new attitudes, providing skills for improving health status and influencing both planners and health care professionals. We also demonstrated that training and education of health care workers and research collaborations can influence policy makers. The collaboration to date has established a model for international collaboration providing both educational and technical support towards capacity building within the country. Collaborations with developing countries will enable the prevention and control of chronic disease in the developing world in keeping with the United Nations resolution regarding diabetes. Copyright © 2009 John Wiley & Sons, Ltd.

Compromised periodontal status in an urban Sri Lankan population with type 2 diabetes

“…These data were obtained from clinical practise records and the absent data were a consequence of the initial practise of clinicians at the outset of our study. The research team, however, as part of a wider contribution to healthcare in Sri Lanka commenced a programme of ongoing education of clinical staff and subsequently, more complete data sets were achieved as recording of HbA1c became routine (Dissanayake et al 2006, Gunathilake et al 2009). Despite this limitation, the power calculation was based on PD as the primary outcome of interest and we are confident that clinical comparisons between diabetes and non‐diabetes subjects are valid whereas observations resulting from the subgroups analyses are less robust.…”

Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review

“…The most common component of all these strategies was organization and equipping of healthcare teams to perform screenings for Diabetes and/or HTN [195, 197, 198, 208, 209, 212], to establish new approach of healthcare [193, 194, 202–204, 207], to use new guidelines and treatment protocols [201, 205, 211], to implement Diabetes program at schools [200], and to improve diabetes and HTN management [196]. Another strong common component at the level of health service organization was Self-management through health education on HTN and/or diabetes or CVD risks [28, 195, 197–199], health promotion [206] and healthy eating and physical activity education [207].…”

“…At the Policy level, Leadership and advocacy including using the media for the promotion of attitudes and health promotion campaigns [199, 204, 206], publicity about new model of health services or National Drug Benefit Package [205, 211], and National guidelines for transition of diabetic children to adult clinics [194]. Supportive legislation provided health promotion policy [209], community-based health – insurance [201], Education guidelines for T1D patients [200], and inclusion of some HTN and Diabetes drugs on pay exemption list [193].…”

“…Remaining components of the presented strategies (Continuity /coordination and Leadership at the level of Health Service Organization, Complementary services and Leadership and support at the Community level, Integrate policies at the Policy level) were identified only in one intervention each through the implementation of LSM program following the established chronogram [210], nurse education program with guidelines adapted to local use and decision support by staff of specialists [199], provision of free anti-hypertensive drugs and distribution of free seeds of vegetables in the communities [207], training of peer-educators by a diabetologist [195], implementation of Integrated Chronic Disease Management (ICDM) model [194] respectively (Table 3).…”

The Impact of a Decision Support Tool Linked to an Electronic Medical Record on Glycemic Control in People with Type 2 Diabetes

“…Both groups of doctors received provider education in the form of educational workshops, meetings, and lectures and educational outreach visits and distribution of educational materials. 9 The HbA1c was measured at each clinic visit. These were scheduled at 3 months, but where patients do not attend, the interval was longer than 3 months.…”