Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya.
Glob Heart. 2023 Jun 15;18(1):32. doi: 10.5334/gh.1213. eCollection 2023.
Integrated chronic disease management is the desired core function of a responsive healthcare system. However, many challenges surround its implementation in Sub-Saharan Africa. The current study assessed the readiness of healthcare facilities to provide integrated management of cardiovascular diseases (CVDs) and type 2 diabetes in Kenya.
We used data from a nationally representative cross-sectional survey of 258 public and private health facilities conducted in Kenya between 2019 and 2020. Data were collected using a standardised facility assessment questionnaire and observation checklists modified from the World Health Organization Package of Essential Non-communicable Diseases. The primary outcome was the readiness to provide integrated care for CVDs and diabetes-defined as the mean availability of tracer items comprising trained staff and clinical guidelines, diagnostic equipment, essential medicines, diagnosis, treatment and follow-up. A cut-off threshold of ≥70% was used to classify facilities as 'ready'. Gardner-Altman plots and modified Poisson regression were used to examine the facility characteristics associated with care integration readiness.
Of the surveyed facilities, only a quarter (24.1%) were ready to provide integrated care for CVDs and type 2 diabetes. Care integration readiness was lower in public versus private facilities [aPR = 0.6; 95% CI 0.4 to 0.9], and primary healthcare facilities were less likely to be ready compared to hospitals [aPR = 0.2; 95% CI 0.1 to 0.4]. Facilities located in Central Kenya [aPR = 0.3; 95% CI 0.1 to 0.9], and the Rift Valley region [aPR = 0.4; 95% CI 0.1 to 0.9], were less likely to be ready compared to the capital Nairobi.
There are gaps in the readiness of healthcare facilities particularly primary healthcare facilities in Kenya to provide integrated care services for CVDs and diabetes. Our findings inform the review of current supply-side interventions for integrated management of CVDs and type 2 diabetes, especially in lower-level public health facilities in Kenya.
综合慢性病管理是响应式医疗体系的理想核心功能。然而，在撒哈拉以南非洲实施这一功能面临许多挑战。本研究评估了肯尼亚医疗机构提供心血管疾病（CVDs）和 2 型糖尿病综合管理的准备情况。
我们使用了 2019 年至 2020 年期间在肯尼亚进行的一项全国代表性的 258 家公立和私立卫生机构的横断面调查数据。数据是通过使用标准化的机构评估问卷和世界卫生组织基本非传染性疾病包修改后的观察清单收集的。主要结果是提供 CVD 和糖尿病综合护理的准备情况，定义为包括培训人员和临床指南、诊断设备、基本药物、诊断、治疗和随访在内的追踪项目的平均可用性。使用≥70%的截值来分类准备就绪的设施。加德纳-奥特曼图和修正泊松回归用于检查与护理整合准备相关的设施特征。
在所调查的设施中，只有四分之一（24.1%）准备好为 CVD 和 2 型糖尿病患者提供综合护理。与私立机构相比，公共机构的护理整合准备程度较低[调整后的比值比（aPR）=0.6；95%置信区间（CI）0.4 至 0.9]，与医院相比，初级保健机构不太可能准备就绪[aPR=0.2；95%CI 0.1 至 0.4]。与首都内罗毕相比，位于肯尼亚中央肯尼亚地区[aPR=0.3；95%CI 0.1 至 0.9]和裂谷地区[aPR=0.4；95%CI 0.1 至 0.9]的设施不太可能准备就绪。
肯尼亚医疗机构，特别是初级保健机构，在提供 CVD 和糖尿病综合护理服务方面准备不足。我们的研究结果为审查目前针对 CVD 和 2 型糖尿病的综合管理的供应方干预措施提供了信息，特别是在肯尼亚的基层公共卫生机构。
