Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205, Geneva, Switzerland.
Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205, Geneva, Switzerland.
BMC Public Health. 2019 Nov 21;19(1):1542. doi: 10.1186/s12889-019-7842-6.
Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs.
Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results.
198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%).
Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.
高血压（HTN）和糖尿病（DM）在中低收入国家（LMIC）中发病率高，是发病率和死亡率的主要原因。最近关于初级保健干预措施有效性的证据引起了人们对实施这些措施的新呼吁。本综述旨在综合评估中低收入国家初级保健干预措施对这两种疾病的有效性的证据。
两名审查员对三个数据库（Pubmed、EMBASE 和 Web of Science）进行了电子检索，并筛选了合格的文章。包括在初级保健或社区一级开展健康促进、预防、治疗或康复活动的干预措施。纳入了 2007 年 1 月至 2017 年 1 月期间以英语、法语、葡萄牙语和西班牙语发表的研究。主要提取变量包括模板干预描述和复制（TIDieR）检查表和指南中确定的 12 个标准。创新性慢性病护理框架（ICCCF）用于指导分析和报告结果。
分析了 198 篇文章。这些策略侧重于医疗服务组织（76.5%）、社区层面（9.7%）、创造积极的政策环境（3.6%）和涵盖多个领域的策略（10.2%）。研究包括以下主题：干预措施的描述或测试（n=81；41.3%）、实施或评估项目（n=42；21.4%）、质量改进倡议（n=15；7.7%）、筛查和预防工作（n=26；13.2%）、高血压或糖尿病管理（n=13；6.6%）、综合卫生服务（n=10；5.1%）、知识和态度调查（n=5；2.5%）、经济有效的实验室测试（n=2；1%）和政策制定工作（n=2；1%）。大多数研究报告了非专家（n=86；43.4%）和多学科团队（n=49；25.5%）的干预措施。
在过去的 10 年中，仅发现了 198 篇文章，这表明在中低收入国家，关于这两种高发病率疾病的研究很少。本综述表明，为了解决中低收入国家的 HTN 和 DM 问题，已经测试了多种方法，这些方法具有多样性和复杂性，并强调了需要解决的干预措施要素，以加强护理的提供。大多数研究报告的实施过程信息很少，无法进行复制。鉴于需要多组件复杂干预措施，研究设计和评估技术将需要进行调整，包括过程评估而不仅仅是效果或结果评估。
