Patient-Centered, Sustainable Hypertension Care: The Case for Adopting a Differentiated Service Delivery Model for Hypertension Services in Low- and Middle-Income Countries

Tisdale, Rebecca; Cazabon, Danielle; Moran, Andrew E.; Rabkin, Miriam; Bygrave, Helen; Cohn, Jennifer

doi:10.5334/gh.978

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…Hypertension and diabetes management has been a particular challenge for LMIC health systems where the burden of uncontrolled diseases is high [48][49][50] . The pandemic could prompt policymakers to rethink the frequency of visits required and consider adopting principles of DSD to meet the needs of people living with these conditions 51 . South Africa has adopted such a strategy through the Central Chronic Medicines Dispensing and Distribution program 52 .…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and resilience of healthcare systems in ten countries

Arsenault

Gage

Kim

et al. 2022

Nat Med

241

223

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Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

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Section: Discussionmentioning

confidence: 99%

COVID-19 and resilience of healthcare systems in ten countries

Arsenault

Gage

Kim

et al. 2022

Nat Med

241

223

View full text Add to dashboard Cite

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“…Even if all aspects of the health of an older individual cannot be addressed with the public health approach, certain conditions that are highly prevalent and amenable to an algorithmic approach to management and could be executed by providers with fewer years of formal medical training can result in substantial gains in further decreasing morbidity and mortality. Such conditions may include well‐controlled hypertension [ 36 ] and diabetes. Mechanisms used to procure drugs for HIV can be extended to diagnostics and treatments for these conditions as well.…”

Section: Discussionmentioning

confidence: 99%

Providing differentiated service delivery to the ageing population of people living with HIV

et al. 2022

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Introduction Differentiated service delivery (DSD) models for HIV are a person‐centred approach to providing services across the HIV care cascade; DSD has an increasing policy and implementation support in high‐burden HIV countries. The life‐course approach to DSD for HIV treatment has focused on earlier life phases, childhood and adolescence, families, and supporting sexual and reproductive health during childbearing years. Older adults, defined as those over the age of 50, represent a growing proportion of HIV treatment cohorts with approximately 20% of those supported by PEPFAR in this age band and have specific health needs that differ from younger populations. Despite this, DSD models have not been designed or implemented to address the health needs of older adults. Discussion Older adults living with HIV are more likely to have significant co‐morbid medical conditions. In addition to the commonly discussed co‐morbidities of hypertension and diabetes, they are at increased risk of cognitive impairment, frailty and mental health conditions. Age and HIV‐related cognitive impairment may necessitate the development of adapted educational materials. Identifying the optimal package of differentiated services to this population, including the frequency of clinical visits, types and location of services is important as is capacitating the healthcare cadres to adapt to these challenges. Technological advances, which have made remote monitoring of adherence and other aspects of disease management easier for younger populations, may not be as readily available or as familiar to older adults. To date, adaptations to service delivery have not been scaled and are limited to nascent programmes working to integrate treatment of common co‐morbidities. Conclusions Older individuals living with HIV may benefit from a DSD approach that adapts care to the specific challenges of ageing with HIV. Models could be developed and validated using outcome measures, such as viral suppression and treatment continuity. DSD models for older adults should consider their specific health needs, such as high rates of co‐morbidities. This may require educational materials, health worker capacity building and outreach designed specifically to treat this age group.

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“…In low-to middle-income settings with a high burden of communicable and non-communicable diseases, adopting differentiated models of care is effective at managing health conditions [115]. The adoption of a differentiated approach to care and management of psoriasis within a low-to middle-income context has important public health implications within the context of multi-morbidity.…”

Section: Psychosocial Management Of Psoriasismentioning

confidence: 99%

Psoriasis: Clinical Features and Its Impact on Quality of Life

Mpofana,

Makgobole,

Thembelenkosini Nxumalo

et al. 2024

Psoriasis - Recent Advances in Diagnosis and Treatment [Working Title]

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Psoriasis is a chronic, papulo-squamous, non-infectious, immune-mediated, and inflammatory skin disorder clinically characterized by erythematous sharply demarcated papules and rounded plaques covered by silvery micaceous scales. It is associated with comorbidities such as psoriatic arthritis, depression, obesity, and cardiovascular disease. Psoriasis can also be a source of self and social rejection, thus contributing to stigmatization, alienation, and a decrease in the quality of life (QoL). Due to its complex pathogenesis, a holistic approach is necessary when treating psoriasis. In addition to treating physical symptoms, the patient’s psychological and emotional health should be highly considered to help individuals cope with stigma. Likewise, an increased social awareness of psoriasis may contribute to a better understanding of the disease. Alternative stress management therapies such as spa therapies using dead sea mud and or balneotherapy, yoga, and aromatherapy may be effective in stress management to improve overall well-being and QoL.

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Patient-Centered, Sustainable Hypertension Care: The Case for Adopting a Differentiated Service Delivery Model for Hypertension Services in Low- and Middle-Income Countries

Cited by 8 publications

References 24 publications

COVID-19 and resilience of healthcare systems in ten countries

COVID-19 and resilience of healthcare systems in ten countries

Providing differentiated service delivery to the ageing population of people living with HIV

Psoriasis: Clinical Features and Its Impact on Quality of Life

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