Centre for Rural Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu Natal, South Africa
Centre for Rural Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu Natal, South Africa.
BMJ Open. 2024 Nov 27;14(11):e087451. doi: 10.1136/bmjopen-2024-087451.
To understand barriers and facilitators for strengthening health systems for person-centred care of people with multiple long-term conditions-multimorbidity (MLTC-M) at the primary healthcare (PHC) level in low-income and middle-income countries (LMICs).
A scoping review.
We adopted a systematic scoping review approach to chart literature guided by Arksey and O'Malley's methodological framework. The review focused on studies conducted in LMICs' PHC settings from January 2010 to December 2023. Papers were extracted from the following databases: PubMed, EBSCOhost and Google Scholar. Framework analysis was undertaken to identify barriers and facilitators for strengthening MLTC-M primary care according to the five health system pillars in the Lancet Global Health Commission on High-Quality Health Systems Framework.
The literature search yielded 4322 citations, evaluated 202 studies and identified 36 for inclusion. Key barriers within the people pillar included poverty, low health education and low health literacy; within the platform pillar, fragmented services and lack of multimorbid care guidelines were mentioned; within the workforce pillar, lack of required skills and insufficient health workers; and in the tools pillar: a shortage of essential medicines and adverse polypharmacy effects were prominent. A lack of political will and the absence of relevant national health policies were identified under the governance pillar. Facilitators within the people pillar included enhancing self-management support; within the platforms, pillar included integration of services; within the tools pillar, included embracing emerging technologies and information and communication technology services; and governance issues included upscaling interventions to respond to multimorbid care needs through enhanced political commitment and financial support.
Potential solutions to strengthening the healthcare system to be more responsive to people with MLTC-M include empowering service users to self-manage, developing multimorbid care guidelines, incorporating community health workers into multimorbid care efforts and advocating for integrated person-centred care services across sectors. The need for policies and procedures in LMICs to meet the person-centred care needs of people with MLTC-M was highlighted.
了解在低收入和中等收入国家（LMICs）的基层医疗保健（PHC）水平上加强以人为中心的多慢性病（MLTC-M）患者的卫生系统的障碍和促进因素。
范围综述。
我们采用了系统范围的综述方法，根据 Arksey 和 O'Malley 的方法学框架绘制文献。该综述重点关注 2010 年 1 月至 2023 年 12 月在 LMICs PHC 环境中进行的研究。论文从以下数据库中提取：PubMed、EBSCOhost 和 Google Scholar。根据 Lancet 全球卫生委员会关于高质量卫生系统框架的五个卫生系统支柱，采用框架分析来确定加强 MLTC-M 初级保健的障碍和促进因素。
文献检索产生了 4322 条引文，评估了 202 项研究，并确定了 36 项纳入研究。人员支柱内的主要障碍包括贫困、低健康教育和低健康素养；平台支柱内提到了服务碎片化和缺乏多疾病护理指南；劳动力支柱内缺乏所需技能和卫生工作者不足；工具支柱内：基本药物短缺和不良药物治疗作用明显。在治理支柱下，发现缺乏政治意愿和缺乏相关国家卫生政策。人员支柱内的促进因素包括增强自我管理支持；平台内的支柱包括服务整合；工具支柱内，包括采用新兴技术和信息和通信技术服务；以及治理问题包括通过增强政治承诺和财政支持，扩大干预措施以满足多疾病护理需求。
加强医疗保健系统以更好地满足 MLTC-M 患者需求的潜在解决方案包括授权服务用户进行自我管理、制定多疾病护理指南、将社区卫生工作者纳入多疾病护理工作以及倡导跨部门的以人为本的综合护理服务。突出强调了在 LMICs 制定政策和程序以满足 MLTC-M 患者以人为本的护理需求的必要性。
