目的:从全球慢性病联盟(GACD)资助的研究人员的工作中,汲取有关非传染性疾病(NCD)初级卫生保健(PHC)服务提供策略的重要经验。
方法:一项融合混合方法研究,该研究使用标准化模板从GACD资助的专注于PHC的研究项目中提取数据。这些研究中实施的策略被映射到PHC绩效计划框架中。与有意选择的项目的研究人员进行了半结构化的定性访谈,以更深入地了解策略和环境因素。
方法:来自低收入或中等收入国家(LMIC)以及高收入国家中的弱势群体的PHC背景。项目来自世界各地,特别是东亚和太平洋地区,撒哈拉以南非洲,南亚,拉丁美洲和加勒比。
方法:该研究提取了84个研究项目的数据,并采访了16个研究项目的研究人员。
结果:研究项目来自世界各地,主要集中在糖尿病(35.3%),高血压(28.3%)和心理健康(27.6%)。映射到PHC绩效计划框架:49.4%的人专注于高质量的PHC(尤其是NCD护理的全面性,41.2%);41.2%关于PHC服务的可用性(特别是医护人员的能力,36.5%);35.3%的人口健康管理(特别是社区服务,35.3%);34.1%的机构组织和管理(特别是基于团队的护理,20.0%)和31.8%的接入(特别是数字技术,23.5%)。最常见的战略是任务转移和培训,以通过社区服务提高非传染性疾病护理的全面性。与投入相关的情境因素:基础设施,设备和药物,劳动力(特别是社区卫生工作者),金融,卫生信息系统和数字技术。
结论:确定了改善低收入国家非传染性疾病PHC服务交付的关键策略和背景因素。这些策略应与其他策略相结合,以加强整个PHC系统,同时改善对非传染性疾病的护理。
OBJECTIVE: To extract key lessons on primary healthcare (PHC) service delivery strategies for non-communicable diseases (NCD) from the work of researchers funded by the Global Alliance for Chronic Diseases (GACD).
METHODS: A convergent mixed methods study that extracted data using a standardised template from research projects funded by the GACD that focused on PHC. The strategies implemented in these studies were mapped onto the PHC Performance Initiative framework. Semistructured qualitative interviews were conducted with researchers from purposefully selected projects to understand the strategies and contextual factors in more depth.
METHODS: PHC contexts from low or middle-income countries (LMIC) as well as vulnerable groups within high-income countries. Projects came from all regions of the world, particularly East Asia and Pacific, sub-Saharan Africa, South Asia, Latin America and Caribbean.
METHODS: The study extracted data on 84 research projects and interviewed researchers from 16 research projects.
RESULTS: Research projects came from all regions of the world, and mainly focused on diabetes (35.3%), hypertension (28.3%) and mental health (27.6%). Mapped onto the PHC Performance Initiative framework: 49.4% focused on high-quality PHC (particularly the comprehensiveness of NCD care, 41.2%); 41.2% on the availability of PHC services (particularly the competence of healthcare workers, 36.5%); 35.3% on population health management (particularly community-based services, 35.3%); 34.1% on facility organisation and management (particularly team-based care, 20.0%) and 31.8% on access (particularly digital technology, 23.5%). Most common strategies were task shifting and training to improve the comprehensiveness of NCD care through community-based services. Contextual factors related to inputs: infrastructure, equipment and medication, workforce (particularly community health workers), finances, health information systems and digital technology.
CONCLUSIONS: Key strategies and contextual factors to improve PHC service delivery for NCDs in LMICs were identified. These strategies should combine with other strategies to strengthen the PHC system as a whole, while improving care for NCDs.