Favas Caroline, Ansbro Éimhín, Eweka Evette, Agarwal Gina, Lazo Porras Maria, Tsiligianni Ioanna, Vedanthan Rajesh, Webster Ruth, Perel Pablo, Murphy Adrianna
London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.
Grossman School of Medicine, New York University, New York, NY, United States.
Public Health Rev. 2022 Jun 27;43:1604583. doi: 10.3389/phrs.2022.1604583. eCollection 2022.
The COVID-19 pandemic has disrupted health care for non-communicable diseases (NCDs) and necessitated strategies to minimize contact with facilities. We aimed to examine factors influencing implementation of remote (non-facility-based) delivery approaches for people with hypertension and/or diabetes in low- and middle-income countries (LMICs), to inform NCD care delivery during health service disruption, including humanitarian crises. Our narrative review used a hermeneutic and purposive approach, including primary studies conducted in LMICs, which assessed implementation factors influencing remote NCD care delivery. Results were analyzed using the Consolidated Framework for Implementation Research. Twenty-eight included studies revealed the strong influence of both internal organizational and broader contextual factors, such as community health worker policies or technological environment. Addressing patients' specific characteristics, needs and resources was important for implementation success. This review highlighted the multiple, complex, interdependent factors influencing implementation of remote NCD care in LMICs. Our findings may inform actors designing NCD care delivery in contexts where facility-based access is challenging. Implementation research is needed to evaluate context-adapted e-Health, community-based, and simplified clinical management strategies to facilitate remote NCD care.
新冠疫情扰乱了非传染性疾病（NCDs）的医疗服务，因此需要采取策略尽量减少与医疗机构的接触。我们旨在研究影响低收入和中等收入国家（LMICs）高血压和/或糖尿病患者远程（非基于医疗机构）治疗方法实施的因素，为包括人道主义危机在内的卫生服务中断期间的非传染性疾病护理提供参考。我们的叙述性综述采用了解释性和目的性方法，包括在低收入和中等收入国家进行的初步研究，这些研究评估了影响远程非传染性疾病护理实施的因素。使用实施研究综合框架对结果进行分析。纳入的28项研究表明，内部组织因素和更广泛的背景因素（如社区卫生工作者政策或技术环境）都有很大影响。关注患者的具体特征、需求和资源对实施成功很重要。本综述强调了影响低收入和中等收入国家远程非传染性疾病护理实施的多种、复杂且相互依存的因素。我们的研究结果可能为在基于医疗机构的医疗服务难以获得的情况下设计非传染性疾病护理服务的行为者提供参考。需要开展实施研究，以评估适应不同环境的电子健康、基于社区的和简化的临床管理策略，以促进远程非传染性疾病护理。
