Nair Divya, Thekkur Pruthu, Fernando Manoj, Kumar Ajay M V, Satyanarayana Srinath, Chandraratne Nadeeka, Chandrasiri Amila, Attygalle Deepika Eranjanie, Higashi Hideki, Bandara Jayasundara, Berger Selma Dar, Harries Anthony D
Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France.
Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Anuradhapura 50300, Sri Lanka.
Healthcare (Basel). 2023 Jan 9;11(2):202. doi: 10.3390/healthcare11020202.
The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0-23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.
斯里兰卡的初级医疗保健系统强化项目专注于改善初级医疗机构（PMCI）的非传染性疾病（NCD）护理服务。我们开展了一项解释性混合方法研究，以评估九家选定的初级医疗机构对非传染性疾病风险的筛查完整性、与护理的衔接情况以及糖尿病/高血压护理的结果，并了解存在差距的原因。在35岁及以上人群中，筛查覆盖率目标为50%，但由于公众缺乏对筛查的认知需求以及与新冠疫情相关的服务中断，初级医疗机构仅达到了23.3%（95%置信区间：23.0 - 23.6%）。几乎一半接受筛查的人没有记录调查结果和进一步转诊的细节。筛查后，45%有资格接受非传染性疾病后续护理的人在医疗诊所登记。缺乏健全的记录/跟踪机制以及对私立医疗机构的偏好导致了筛查后的人员流失。由于医疗服务提供者未开具检查医嘱，且初级医疗机构无法提供检查，患者需自费到私立部门接受服务，超过50%的糖尿病/高血压患者未进行用于监测并发症的后续生化检查。加强初级保健需要应对这些挑战，以确保非传染性疾病护理在初级医疗机构中成功整合。
