How have researchers defined and used the concept of ‘continuity of care’ for chronic conditions in the context of resource-constrained settings? A scoping review of existing literature and a proposed conceptual framework

Abstract

Background Within the context of the growing burden of non-communicable diseases (NCDs) globally, there is limited evidence on how researchers have explored the response to chronic health needs in the context of health policy and systems in low- and middle-income countries. Continuity of care (CoC) is one concept that represents several elements of a long-term model of care. This scoping review aims to map and describe the state of knowledge regarding how researchers in resource-constrained settings have defined and used the concept of CoC for chronic conditions in primary healthcare. Methods This scoping review adopted the modified framework for interpretive scoping literature reviews. A systematic literature search in PubMed was performed, followed by a study selection process and data extraction, analysis and synthesis. Extracted data regarding the context of using CoC and the definition of CoC were analysed inductively to identify similar patterns; based on this, articles were divided into groups. MaxQDA was then used to re-code each article with themes according to the CoC definition to perform a cross-case synthesis under each identified group. Results A total of 55 peer-reviewed articles, comprising reviews or commentaries and qualitative or quantitative studies, were included. The number of articles has increased over the years. Five groups were identified as those (1) reflecting a change across stages or systems of care, (2) mentioning continuity or lack of continuity without a detailed definition, (3) researching CoC in HIV/AIDS programmes and its scaling up to support management of NCDs, (4) researching CoC in NCD management, and (5) measuring CoC with validated questionnaires. Conclusion Research or policy documents need to provide an explicit definition of CoC when this terminology is used. A framework for CoC is suggested, acknowledging three components for CoC (i.e. longitudinal care, the nature of the patient–provider relationship and coordinated care) while considering relevant contextual factors, particularly access and quality. Electronic supplementary material The online version of this article (10.1186/s12961-019-0426-1) contains supplementary material, which is available to authorized users.

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

“…Fifth, as LMICs are facing an emerging burden of NCDs, there are increased global calls on the role of strengthening primary health care and ensuring universal health coverage in their prevention and control, especially to achieve a challenging need for NCDs patients represented by the continuity of care [83][84][85]. Continuity of care is aimed to provide patients with coherent life-long care in three essential dimensions: longitudinal care, the nature of the patient-provider relationship, and coordinated care across levels and disciplines [86]. Given that many LMICs, especially in sub-Saharan Africa, have experienced continuity of care through HIV programmes, many practical examples of successful HIV interventions were proposed for possible extension to NCDs such as care delivered with a family focus; paperbased or electronic appointment systems for scheduled follow-up; on-site medical records; mobile phone applications or SMS reminders; use of peer educators and patient groups for counselling and adherence support; standardised treatment protocols; and task shifting and task sharing [87,88].…”

“…Furthermore, Levenseque et al argued that these characteristics are not independent, but they interact and influence each other differently during an episode of illness and care [11]. For people living with HTN, their health-care needs include continuity of care defined as 'the provision of coordinated care and services over time and across levels and disciplines, which is coherent with the patient's health needs and personal circumstances' [28]. The need for continuity of care is reflected in the framework by examining the activation of the access process by an empowered patient beyond the first contact, as it is relevant each time the patient attempts to access care [11].…”

Access to Care and Prevalence of Hypertension and Diabetes Among Syrian Refugees in Northern Jordan

“…The reported use of medication, however, represents self-reported access at 1 point in time rather than long-term access or adherence. Without complementary strategies, basic management may diminish the concept of care to mainly drug management 5,31. Certain risk groups should be targeted by primary and secondary prevention to avoid severe disease, complications, and mortality.…”

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

“…Interview guides for both patients and providers were developed to capture issues related to the provision of chronic care ( Wagner, 1998 ; WHO, 2002 ; Meiqari et al , 2019a ); they covered the following main areas: first contact, service delivery and continuity of care. Patients’ interviews started with a timeline mapping, in which patients indicated essential events in the course of their disease from diagnosis to current treatment; this exercise aimed to ‘encourage rapport building by reducing traditional hierarchies of a research interview’ and to ‘allow the participants to create a sense of direction of what they wanted to share when asked the interview questions’ ( Kolar et al , 2015 ).…”