George Washington University, 950 New Hampshire Ave, Washington, D.C., USA; Weill Cornell Medical College, 420 East 70(th) St, New York, NY, USA.
Lenox Hill Hospital of Northwell Health, Hofstra University, New York, USA.
Prev Med. 2022 Aug;161:107154. doi: 10.1016/j.ypmed.2022.107154. Epub 2022 Jul 9.
Large number of people with non-communicable diseases (NCDs) face barriers to adequate healthcare in humanitarian settings. We conducted a systematic literature review in MEDLINE/PubMed, Web of Science, EMBASE/DARE, Cochrane, and grey literature from 1990 to 2021 to evaluate effective strategies in addressing NCDs (diabetes, cardiovascular diseases, COPD, cancer) in humanitarian settings. From 2793 articles, 2652 were eliminated through title/abstract screening; 141 articles were reviewed in full; 93 were eliminated for not meeting full criteria. Remaining 48 articles were reviewed qualitatively to assess populations, settings, interventions, outcome, and efficacy and effectiveness; 38 studies addressed treatments, 9 prevention, and 7 epidemiology. Prevention studies broadly addressed capacity-building. Treatment and epidemiology studies largely addressed hypertension and diabetes. Interventions included web-based/mobile health strategies, pharmacy-level interventions, portable imaging, and capacity building including physical clinics, staff training, forging collaborations, guideline development, point-of-care labs, health promotion activities, EMR, and monitoring interventions. Collaboration between academia and implementing agencies was limited. Models of care were largely not well-described and varied between studies due to contextual constraints. Barriers to interventions included financial, logistical, organizational, sociocultural, and security. Cancer care is significantly understudied. Simplified care models adapted to contexts and program evaluations of implemented strategies could address gaps in applied research. Inherent challenges in humanitarian settings pose unavoidable perils to evidence generation which requires a shift in research mindset to match aspirations with practicality, research collaborations at the inception of projects, reworking of desired conventional level of research evidence considering resource-intense constraints (HR, time, cost), and adapted research tools, methods, and procedures.
大量患有非传染性疾病（NCDs）的人在人道主义环境中面临获得足够医疗保健的障碍。我们在 1990 年至 2021 年期间在 MEDLINE/PubMed、Web of Science、EMBASE/DARE、Cochrane 和灰色文献中进行了系统文献回顾，以评估在人道主义环境中解决非传染性疾病（糖尿病、心血管疾病、COPD、癌症）的有效策略。在 2793 篇文章中，通过标题/摘要筛选排除了 2652 篇；141 篇文章进行了全文审查；93 篇因不符合全部标准而被排除。其余 48 篇文章进行了定性审查，以评估人群、环境、干预措施、结果以及效果和有效性；38 项研究涉及治疗方法，9 项预防措施，7 项流行病学研究。预防研究广泛涉及能力建设。治疗和流行病学研究主要涉及高血压和糖尿病。干预措施包括基于网络/移动健康的策略、药房级干预措施、便携式成像、以及包括物理诊所、员工培训、建立合作关系、制定指南、即时护理实验室、健康促进活动、电子病历和监测干预措施在内的能力建设。学术界和实施机构之间的合作有限。护理模式在很大程度上没有得到很好的描述，并且由于背景限制，在研究之间存在差异。干预措施面临的障碍包括财务、后勤、组织、社会文化和安全。癌症护理的研究明显不足。适应背景的简化护理模式和对实施策略的方案评估可以解决应用研究中的空白。人道主义环境固有的挑战给证据生成带来了不可避免的危险，这需要将研究思路转变为将愿望与实际情况相匹配，在项目开始时进行研究合作，重新考虑所需的常规研究证据水平，考虑到资源密集型限制（人力资源、时间、成本），并采用适应性研究工具、方法和程序。
