Chronic Disease Management Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
BMJ Open. 2023 Aug 11;13(8):e074274. doi: 10.1136/bmjopen-2023-074274.
Understanding the facilitators and barriers to managing hypertension and type 2 diabetes (T2D) will inform the design of a contextually appropriate integrated chronic care model in Kenya. We explored the perceived facilitators and barriers to the integrated management of hypertension and T2D in Kenya using the Rainbow Model of Integrated Care.
This was a qualitative study using data from a larger mixed-methods study on the health system response to chronic disease management in Kenya, conducted between July 2019 and February 2020. Data were collected through 44 key informant interviews (KIIs) and eight focus group discussions (FGDs).
Multistage sampling procedures were used to select a random sample of 12 study counties in Kenya.
The participants for the KIIs comprised purposively selected healthcare providers, county health managers, policy experts and representatives from non-state organisations. The participants for the FGDs included patients with hypertension and T2D.
Patients' and providers' perspectives of the health system facilitators and barriers to the integrated management of hypertension and T2D in Kenya.
The clinical integration facilitators included patient peer support groups for hypertension and T2D. The major professional integration facilitators included task shifting, continuous medical education and integration of community resource persons. The national referral system, hospital insurance fund and health management information system emerged as the major facilitators for organisational and functional integration. The system integration facilitators included decentralisation of services and multisectoral partnerships. The major barriers comprised vertical healthcare services characterised by service unavailability, unresponsiveness and unaffordability. Others included a shortage of skilled personnel, a lack of interoperable e-health platforms and care integration policy implementation gaps.
Our study identified barriers and facilitators that may be harnessed to improve the integrated management of hypertension and T2D. The facilitators should be strengthened, and barriers to care integration redressed.
了解肯尼亚在高血压和 2 型糖尿病（T2D）管理方面的促进因素和障碍因素，将为设计一个具有本土特色的综合慢性病护理模式提供信息。我们使用综合护理彩虹模型（Rainbow Model of Integrated Care），探索了肯尼亚在高血压和 T2D 综合管理方面的感知促进因素和障碍因素。
这是一项定性研究，使用了肯尼亚对慢性病管理的卫生系统应对措施进行的一项更大的混合方法研究的数据，数据收集时间为 2019 年 7 月至 2020 年 2 月。数据通过 44 次关键知情人访谈（KII）和 8 次焦点小组讨论（FGD）收集。
使用多级抽样程序，在肯尼亚随机选择了 12 个研究县。
KII 的参与者包括有目的选择的医疗保健提供者、县卫生管理人员、政策专家和非国家组织的代表。FGD 的参与者包括高血压和 T2D 患者。
肯尼亚高血压和 T2D 综合管理中卫生系统促进因素和障碍因素的患者和提供者观点。
临床整合的促进因素包括高血压和 T2D 的患者同伴支持小组。主要的专业整合促进因素包括任务转移、持续的医学教育和社区资源人员的整合。国家转诊系统、医院保险基金和卫生管理信息系统是组织和功能整合的主要促进因素。系统整合的促进因素包括服务的权力下放和多部门伙伴关系。主要障碍包括垂直医疗服务的特点是服务不可用、无响应和不可负担。其他障碍包括熟练人员短缺、缺乏互操作的电子卫生平台以及护理整合政策执行差距。
我们的研究确定了可能被利用来改善高血压和 T2D 综合管理的促进因素和障碍因素。应加强促进因素，解决护理整合的障碍。
