Improving services for chronic non-communicable diseases in Samoa: an implementation research study using the care cascade framework
Improving services for chronic non-communicable diseases in Samoa: an implementation research study using the care cascade framework
复制标题
DOI：
10.1111/1753-6405.13113
复制
发表时间：
2021-07-26
影响因子：
3.5
通讯作者：
Zhang, Shuo
中科院分区：
文献类型：
--
作者：
Fraser-Hurt, Nicole;Naseri, Leausa Take;Zhang, Shuo
目标：萨摩亚需要加强应对日益严重的非传染性疾病负担。本研究的目的是评估瓶颈的护理连续性，并确定可能的solutions.Methods：混合方法的研究使用级联框架作为分析工具和高血压作为示踪条件的慢性非传染性疾病。结果：高血压患病率为38.1%，但只有4.7%的高血压患者血压得到控制。有很大的差距，特别是在筛选和转介，由于多重社会文化，经济和服务提供的制约因素。结论：在萨摩亚，慢性非传染性疾病的护理不能有效地解决病人的需求。这就要求更好地开展卫生宣传、创造需求、提供治疗支助、采取营养干预措施和重新设计卫生服务，重点是初级保健以及有效的病人和社区参与。必须重新设计保健系统，以确保护理的连续性和更有效的初级预防。研究结果对该区域面临类似挑战的其他国家也有帮助。
Objective: Samoa needs to intensify the response to the growing non-communicable disease burden. This study aimed to assess bottlenecks in the care continuum and identify possible solutions.Methods: The mixed-methods study used the cascade framework as an analysis tool and hypertension as a tracer condition for chronic non-communicable diseases. Household survey data were integrated with medical record data of hypertension patients and results from focus group discussions with patients and healthcare providers.Results: Hypertension prevalence was 38.1% but only 4.7% of hypertensive individuals had controlled blood pressure. There were large gaps in the care continuum especially at screening and referral due to multiple socio-cultural, economic and service delivery constraints.Conclusions: In Samoa, care for chronic non-communicable diseases is not effectively addressing patient needs. This calls for better health communication, demand creation, treatment support, nutritional interventions and health service redesign, with a focus on primary healthcare and effective patient and community engagement.Implications for public health: The proposed actions can improve the reach, accessibility, quality and effectiveness of Samoa's chronic care services. Health system redesign is necessary to ensure continuity of care and more effective primary prevention. The findings are useful for other countries in the region facing similar challenges.