Boudreaux Chantelle, Wroe Emily B, Thapa Ada, Abebe Natnael A, Akiteng Ann R, Drown Laura, Gadewar Abhijit, Karmacharya Biraj M, Karki Sandeepa, Mansoor Maryam, Mutagaywa Reuben, Mulenga Bavin, Mutengerere Alvern, Nollino Laura, Salvi Devashri, Dagnaw Wubaye Walelgne, Bukhman Gene, Mocumbi Ana O, Adler Alma
Division of Global Health Equity, Center for Integration Science in Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Department of Global Health and Social Medicine, Program in Global NCDs and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America.
PLOS Glob Public Health. 2025 May 5;5(5):e0004552. doi: 10.1371/journal.pgph.0004552. eCollection 2025.
Severe chronic noncommunicable diseases pose a significant health burden and challenges for health systems globally. This study aims to advance our understanding of the current organization of care for these conditions in low and lower-middle-income countries. The study was conducted as part of a baseline assessment of facilities prior to the initiation of the Package of Essential NCD Interventions -Plus (PEN-Plus) strategy, which is designed to enhance outpatient care for conditions including rheumatic and congenital heart disease, sickle cell disease, type 1 diabetes, severe asthma, and advanced chronic kidney disease. We employed a cross-sectional survey methodology to collect baseline data from 16 hospitals in nine LLMICs. The survey assessed the organization of common and severe NCD services, focusing on the availability and management of severe NCDs, organized into domains of integrated services. Data were analyzed using summary statistics and heatmaps to evaluate care patterns. We document gaps in the availability of services for both common and severe NCDs. We find that the majority of NCD care occurs in the general outpatient settings, with a smaller proportion provided in specialized internal medicine wards. Despite some hospitals implementing specialized clinics and teams, limitations in specialist access, variability in service fees, and inconsistent definitions of patient follow-up were prominent issues affecting patient care access and continuity. Despite the spectrum of strategies employed by these hospitals to cater to chronically and severely ill patients, notable gaps in care persist, particularly for diagnostic and treatment options that require specialist training or equipment. The sustainable decentralization of effective care for individuals with severe chronic NCDs will require integrated teams and customized systems to ensure seamless and comprehensive care through the entire care continuum-from screening and diagnosis to care linkage, ongoing management, handling of complications, uninterrupted supply of medicines and commodities and maintaining patient retention.
严重慢性非传染性疾病给全球卫生系统带来了巨大的健康负担和挑战。本研究旨在加深我们对低收入和中低收入国家这些疾病当前护理组织情况的理解。该研究是在启动基本非传染性疾病综合干预套餐升级版（PEN-Plus）战略之前对设施进行基线评估的一部分，该战略旨在加强对包括风湿性和先天性心脏病、镰状细胞病、1型糖尿病、重度哮喘和晚期慢性肾病等疾病的门诊护理。我们采用横断面调查方法，从9个中低收入国家的16家医院收集基线数据。该调查评估了常见和严重非传染性疾病服务的组织情况，重点关注严重非传染性疾病的可及性和管理，这些被组织成综合服务领域。使用汇总统计数据和热图对数据进行分析，以评估护理模式。我们记录了常见和严重非传染性疾病服务可及性方面的差距。我们发现，大多数非传染性疾病护理在普通门诊环境中进行，在专科内科病房提供的比例较小。尽管一些医院设立了专科诊所和团队，但专科就诊受限、服务费用差异以及患者随访定义不一致等问题是影响患者获得护理和护理连续性的突出问题。尽管这些医院采用了一系列策略来照顾慢性病患者和重症患者，但护理方面仍存在明显差距，特别是对于需要专科培训或设备的诊断和治疗选择。要实现对严重慢性非传染性疾病患者有效护理的可持续分散化，将需要综合团队和定制系统，以确保在整个护理连续过程中提供无缝且全面的护理，从筛查和诊断到护理衔接、持续管理、并发症处理、药品和物资的不间断供应以及维持患者留存率。
