Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries

Adler, Alma J; Drown, Laura; Boudreaux, Chantelle; Coates, Matthew M; Marx, Andrew; Akala, Oyetayo; Waqanivalu, Temo; Xu, Hongyi; Bukhman, Gene

doi:10.1186/s12913-023-09072-9

Cited by 9 publications

(9 citation statements)

References 23 publications

(22 reference statements)

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“…Although a number of primary health care models of NCD care have been developed in sub-Saharan Africa, few have described an integrated, decentralized approach at the community level. A recent review of NCD and mental health interventions identi ed 188 studies of which only 29 were conducted in low-income countries [11]. Of these, just 11 were at the community or health centre level, and most focussed on a single disease or were small-scale pilot studies.…”

Section: Discussionmentioning

confidence: 99%

Scaling up noncommunicable disease care in a resource-limited context: lessons learned and implications for policy

Mamo,

Mekoro,

Phillips

et al. 2024

Preprint

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Background: Although primary care models for the care of common noncommunicable diseases (NCD) have been developed in sub-Saharan Africa, few have described an integrated, decentralized approach at the community level. We report the results of a four-year, Ethiopian project to expand this model of NCD care to 15 primary hospitals and 45 health centres encompassing a wide geographical spread and serving a population of approximately 7.5 million people. Methods: Following baseline assessment of the 60 sites, 30 master trainers were used to cascade train a total of 621 health workers in the diagnosis, management and health education of the major common NCDs identified in a scoping review (hypertension, diabetes, chronic respiratory disease and epilepsy). Pre- and post-training assessments and regular mentoring visits were carried out to assess progress and remedy supply or equipment shortages and establish reporting systems. The project was accompanied by a series of community engagement activities to raise awareness and improve health seeking behaviour. Results: A total of 643,296 people were screened for hypertension and diabetes leading to a new diagnosis in 24,313 who were started on treatment. Significant numbers of new cases of respiratory disease (3,986) and epilepsy (1,925) were also started on treatment. Mortality rates were low except for hypertension in the rural health centres where 311 (10.2%) died during the course of the project. Loss to follow up (LTFU), defined as failure to attend clinic for >6 months despite reminders, was low in the hospitals but represented a significant problem in the urban and rural health centres with up to 20 to 30 % of patients with hypertension or diabetes absenting from treatment by the end of the project. Estimates of the population disease burden enrolled within the project, however, were disappointing; asthma (0.49%), hypertension (1.7%), epilepsy (3.3%) and diabetes (3.4%). Conclusion: This project demonstrates the feasibility of scaling up integrated NCD services in a variety of locations, with modest cost and methodology that is replicable and highly sustainable. However, the relatively small gain in the detection and treatment of common NCDs highlights the huge challenge in making NCD services available to all.

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Section: Discussionmentioning

confidence: 99%

Scaling up noncommunicable disease care in a resource-limited context: lessons learned and implications for policy

Mamo,

Mekoro,

Phillips

et al. 2024

Preprint

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“…A recent scoping review that summarised the characteristics of integrated care for NCDs and mental health in LMICs [ 45 ] also found that models of care were complex and heterogenous. Authors described the models of care according to pre-specified dimensions, of which the following mirror components that we identified: the condition, type of service, health care provider and health system level (where care was provided).…”

Section: Discussionmentioning

confidence: 99%

Models of integrated care for multi-morbidity assessed in systematic reviews: a scoping review

Rohwer,

Toews,

Uwimana-Nicol

et al. 2023

BMC Health Serv Res

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Background The prevalence of multi-morbidity is increasing globally. Integrated models of care present a potential intervention to improve patient and health system outcomes. However, the intervention components and concepts within different models of care vary widely and their effectiveness remains unclear. We aimed to describe and map the definitions, characteristics, components, and reported effects of integrated models of care in systematic reviews (SRs). Methods We conducted a scoping review of SRs according to pre-specified methods (PROSPERO 2019 CRD42019119265). Eligible SRs assessed integrated models of care at primary health care level for adults and children with multi-morbidity. We searched in PubMed (MEDLINE), Embase, Cochrane Database of Systematic Reviews, Epistemonikos, and Health Systems Evidence up to 3 May 2022. Two authors independently assessed eligibility of SRs and extracted data. We identified and described common components of integrated care across SRs. We extracted findings of the SRs as presented in the conclusions and reported on these verbatim. Results We included 22 SRs, examining data from randomised controlled trials and observational studies conducted across the world. Definitions and descriptions of models of integrated care varied considerably. However, across SRs, we identified and described six common components of integrated care: (1) chronic conditions addressed, (2) where services were provided, (3) the type of services provided, (4) healthcare professionals involved in care, (5) coordination and organisation of care and (6) patient involvement in care. We observed differences in the components of integrated care according to the income setting of the included studies. Some SRs reported that integrated care was beneficial for health and process outcomes, while others found no difference in effect when comparing integrated care to other models of care. Conclusions Integrated models of care were heterogeneous within and across SRs. Information that allows the identification of effective components of integrated care was lacking. Detailed, standardised and transparent reporting of the intervention components and their effectiveness on health and process outcomes is needed.

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“…Patients seek hospitals capable of providing complete and thorough care, from diagnosis to follow-up and rehabilitation. Hospitals that can provide sustainable and coordinated services are more likely to be chosen by patients for service reuse because this creates comfort and trust in their treatment process (26).…”

Section: The Influence Of Service On Reuse Of Outpatient Servicesmentioning

confidence: 99%

Utilization of repeat services in the outpatient department of Dewi Sartika general hospital, Kendari City, 2023

Muhammad Al Rajab,

Fajar Kurniawan,

Tawakkal

et al. 2024

World J. Bio. Pharm. Health Sci.

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The reutilization of services in outpatient clinics of hospitals plays a crucial role in enhancing the quality and effectiveness of healthcare services. This study aims to analyze the factors associated with service reutilization in hospital outpatient clinics using a cross-sectional design and quantitative approach. Data were collected through questionnaires from 100 respondents at Dewi Sartika General Hospital in Kendari, Southeast Sulawesi, during October-November 2023, using accidental sampling techniques. The analysis results indicate that factors such as service quality, family encouragement, facilities, location, and patient attitudes are significantly associated with service reutilization in outpatient clinics. Univariate analysis was used to describe sample and variable characteristics, while bivariate analysis involved correlation testing to evaluate the relationships among variables. The conclusion of this study highlights the importance of enhancing communication, education, and family support in influencing patient decisions to reuse the same services at the hospital. The development of family support programs, patient empowerment, family-friendly policies, and periodic program evaluations are crucial steps in improving patient experiences and healthcare outcomes. Recommendations include critical steps such as enhancing communication, education, and family support, as well as developing structured family support programs, empowering patients, implementing family-friendly policies, and conducting regular program evaluations. It is expected that the implementation of these recommendations will improve patient experience, enhance adherence to treatment, and overall improve healthcare outcomes.

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Understanding integrated service delivery: a scoping review of models for noncommunicable disease and mental health interventions in low-and-middle income countries

Cited by 9 publications

References 23 publications

Scaling up noncommunicable disease care in a resource-limited context: lessons learned and implications for policy

Scaling up noncommunicable disease care in a resource-limited context: lessons learned and implications for policy

Models of integrated care for multi-morbidity assessed in systematic reviews: a scoping review

Utilization of repeat services in the outpatient department of Dewi Sartika general hospital, Kendari City, 2023

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