A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa.
A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa.
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DOI：
10.1186/s12875-017-0613-5
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发表时间：
2017-03-23
影响因子：
2.9
通讯作者：
Sodhi S
中科院分区：
文献类型：
--
作者：
Kane J;Landes M;Carroll C;Nolen A;Sodhi S
慢性病，主要是心血管疾病、呼吸道疾病、糖尿病和癌症，是全世界死亡和残疾的主要原因。在撒哈拉以南非洲，传染性疾病的患病率仍然超过非传染性疾病，非传染性疾病的发病率正在迅速上升，需要有证据证明这些新出现的非传染性疾病的初级卫生保健方法。SSA慢性病初级保健方法的系统综述和证据综合。其中包括侧重于非传染性疾病优先干预措施的定量和定性初步研究。使用的方法是最佳拟合框架合成。确定了低收入和中等收入国家非传染性疾病护理的三个概念模式，并用于制定综合报告的先验框架。相关主要研究的文献检索生成了3759篇唯一引文，其中12篇符合纳入标准。11项研究是定量的，1项使用混合方法。产生了三个较高级别的主题，即疾病的筛查、预防和管理。这种综合有助于制定一个新的以证据为基础的概念模型，用于照顾撒哈拉以南非洲地区的重点非传染性疾病。对于这次审查，有一个接近共识，即被动而不是主动的病例发现方法是适合在资源匮乏的环境。通过对饮食和生活方式的建议来改变现有患者的风险因素是医疗保健方法的一个共同要素。初级保健疾病管理的优先事项被确定为：在地方初级保健诊所提供基本诊断工具和药物，以及使用标准化的诊断、治疗、监测和转诊到专家护理的协议。本文的在线版本（doi：10.1186/s12875-017-0613-5）包含补充材料，可供授权用户使用。
Chronic diseases, primarily cardiovascular disease, respiratory disease, diabetes and cancer, are the leading cause of death and disability worldwide. In sub-Saharan Africa (SSA), where communicable disease prevalence still outweighs that of non-communicable disease (NCDs), rates of NCDs are rapidly rising and evidence for primary healthcare approaches for these emerging NCDs is needed. A systematic review and evidence synthesis of primary care approaches for chronic disease in SSA. Quantitative and qualitative primary research studies were included that focused on priority NCDs interventions. The method used was best-fit framework synthesis. Three conceptual models of care for NCDs in low- and middle-income countries were identified and used to develop an a priori framework for the synthesis. The literature search for relevant primary research studies generated 3759 unique citations of which 12 satisfied the inclusion criteria. Eleven studies were quantitative and one used mixed methods. Three higher-level themes of screening, prevention and management of disease were derived. This synthesis permitted the development of a new evidence-based conceptual model of care for priority NCDs in SSA. For this review there was a near-consensus that passive rather than active case-finding approaches are suitable in resource-poor settings. Modifying risk factors among existing patients through advice on diet and lifestyle was a common element of healthcare approaches. The priorities for disease management in primary care were identified as: availability of essential diagnostic tools and medications at local primary healthcare clinics and the use of standardized protocols for diagnosis, treatment, monitoring and referral to specialist care. The online version of this article (doi:10.1186/s12875-017-0613-5) contains supplementary material, which is available to authorized users.