Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Glob Health. 2023 Mar 3;13:06006. doi: 10.7189/jogh.13.06006.
During the COVID-19 pandemic, access to health care for people living with non-communicable diseases (NCDs) has been significantly disrupted. Calls have been made to adapt health systems and innovate service delivery models to improve access to care. We identified and summarized the health systems adaptions and interventions implemented to improve NCD care and their potential impact on low- and middle-income countries (LMICs).
We comprehensively searched Medline/PubMed, Embase, CINAHL, Global Health, PsycINFO, Global Literature on coronavirus disease, and Web of Science for relevant literature published between January 2020 and December 2021. While we targeted articles written in English, we also included papers published in French with abstracts written in English.
After screening 1313 records, we included 14 papers from six countries. We identified four unique health systems adaptations/interventions for restoring, maintaining, and ensuring continuity of care for people living with NCDs: telemedicine or teleconsultation strategies, NCD medicine drop-off points, decentralization of hypertension follow-up services and provision of free medication to peripheral health centers, and diabetic retinopathy screening with a handheld smartphone-based retinal camera. We found that the adaptations/interventions enhanced continuity of NCD care during the pandemic and helped bring health care closer to patients using technology and easing access to medicines and routine visits. Telephonic aftercare services appear to have saved a significant amount of patients' time and funds. Hypertensive patients recorded better blood pressure controls over the follow-up period.
Although the identified measures and interventions for adapting health systems resulted in potential improvements in access to NCD care and better clinical outcomes, further exploration is needed to establish the feasibility of these adaptations/interventions in different settings given the importance of context in their successful implementation. Insights from such implementation studies are critical for ongoing health systems strengthening efforts to mitigate the impact of COVID-19 and future global health security threats for people living with NCDs.
在 COVID-19 大流行期间，人们获得非传染性疾病（NCDs）的医疗服务受到了严重影响。有人呼吁调整卫生系统并创新服务提供模式，以改善获得护理的机会。我们确定并总结了为改善 NCD 护理而实施的卫生系统调整和干预措施及其对中低收入国家（LMICs）的潜在影响。
我们全面搜索了 Medline/PubMed、Embase、CINAHL、全球健康、PsycINFO、全球冠状病毒疾病文献和 Web of Science，以获取 2020 年 1 月至 2021 年 12 月期间发表的相关文献。虽然我们以英文撰写的文章为目标，但我们也包括了用法语发表并附有英文摘要的论文。
在筛选了 1313 条记录后，我们从六个国家纳入了 14 篇论文。我们确定了四个独特的卫生系统调整/干预措施，用于恢复、维持和确保 NCD 患者的护理连续性：远程医疗或远程咨询策略、NCD 药物投放点、高血压随访服务的去中心化和向周边卫生中心提供免费药物，以及使用手持式智能手机视网膜相机进行糖尿病性视网膜病变筛查。我们发现，这些调整/干预措施在大流行期间增强了 NCD 护理的连续性，并通过利用技术使医疗保健更接近患者，以及方便药物和常规就诊，帮助改善了医疗保健服务。电话随访服务似乎为患者节省了大量的时间和资金。高血压患者在随访期间的血压控制情况更好。
虽然识别的卫生系统调整措施和干预措施导致 NCD 护理的获得得到了潜在改善，并且临床结果有所改善，但鉴于在其成功实施中背景的重要性，需要进一步探索这些调整/干预措施在不同环境中的可行性。此类实施研究的结果对于正在进行的卫生系统加强努力以减轻 COVID-19 对 NCD 患者的影响和未来全球卫生安全威胁至关重要。
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