Preparedness for delivering non-communicable disease services in primary care: access to medicines for diabetes and hypertension in a district in south India.
Preparedness for delivering non-communicable disease services in primary care: access to medicines for diabetes and hypertension in a district in south India.
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DOI：
10.1136/bmjgh-2017-000519
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发表时间：
2017-01-01
影响因子：
8.1
通讯作者：
Srinivas, Prashanth N
中科院分区：
文献类型：
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作者：
Elias, Maya Annie;Pati, Manoj Kumar;Srinivas, Prashanth N
简介：非传染性疾病（NCD）已成为全球主要的公共卫生挑战;在低收入和中等收入国家（LMICs），每年有2800万人死于非传染性疾病。与许多其他低收入国家一样，印度正在努力为大量受非传染性疾病影响的人口组织高质量的护理，特别是在初级卫生保健一级。本研究的目的是评估当地的卫生系统准备在印度南部的初级保健环境，以解决糖尿病和hypertension.METHODS：本文借鉴了混合方法的研究，在图姆库尔，卡纳塔克邦，印度进行的药物获取研究。我们使用了来自家庭和卫生设施调查的定量数据，以及来自焦点小组讨论和对卫生工作者和患者的深入访谈的定性数据。我们确定了系统的驱动因素，影响利用服务在政府初级卫生中心（PHCs）使用定性数据的专题分析和系统框架获得药品，以评估供求方factors.RESULTS：大多数家庭依赖于私人设施的糖尿病和高血压护理，因为缺乏实验室设施和经常药品缺货在PHCs。与这一议程在全球和国家一级的重要性相比，为非传染性疾病分配财政和管理资源以及将与非传染性疾病有关的护理和进程列为优先事项并不理想。初级卫生保健有一个有限的作用，即使在国家计划下的活动，解决糖尿病和hypertension.DISCUSSION：这项研究发现，在组织和管理糖尿病和高血压护理的初级卫生保健和地区卫生系统的准备关键差距。由于缺乏通过初级保健中心组织的持续护理，患者依赖于私营部门的昂贵且往往是间歇性的护理。有必要改善地区层面对糖尿病和高血压（以及其他非传染性疾病）的管理和财政资源分配。试验注册编号：CTRI/2015/03/005640;初步结果。
INTRODUCTION: Non-communicable diseases (NCDs) have become a major public health challenge worldwide; they account for 28million deaths per year in low-and-middle-income countries (LMICs). Like many other LMICs, India is struggling to organise quality care for a large NCD-affected population especially at the primary healthcare level. The aim of this study was to assess local health system preparedness in a south Indian primary healthcare setting for addressing diabetes and hypertension.METHODS: This paper draws on a mixed-methods research study on access to medicines conducted in Tumkur, Karnataka, India. We used quantitative data from household and health facility surveys, and qualitative data from focus group discussions and in-depth interviews with health workers and patients. We identified systemic drivers that influence utilisation of services at government primary health centres (PHCs) using thematic analysis of qualitative data and a systems framework on access to medicines to assess supply and demand side factors.RESULTS: Majority of households depend on private facilities for diabetes and hypertension care because of the lack of laboratory facilities and frequent medicine stockouts at PHCs. Financial and managerial resource allocation for NCDs and prioritisation of care and processes related to NCDs was suboptimal compared to the prominence of this agenda at global and national levels. Primary healthcare has a limited role even in the activities under the national programme that addresses diabetes and hypertension.DISCUSSION: The study finds critical gaps in the preparedness of PHCs and district health systems in organising and managing care for diabetes and hypertension. Due to the lack of continuous care organised through PHCs, patients depend on expensive and often episodic care in the private sector. There is a need to improve managerial and financial resource allocation towards diabetes and hypertension (and other NCDs) at the district level.TRIAL REGISTRATION NUMBER: CTRI/2015/03/005640; Pre-results.