Organization of primary health care for diabetes and hypertension in high, low and middle income countries

Abstract

Chronic non-communicable diseases, predominantly diabetes and cardiovascular disease are a major public health problem globally. The chronicity of these diseases necessitates a restructuring of healthcare to address the multidisciplinary, sustained care including psychosocial support and development of self-management skills. Primary healthcare with elements of the chronic-care model provides the best opportunity for engagement with the health system. In this review, the authors discuss aspects of primary healthcare for management of diabetes and hypertension and innovations such as mobile-phone messaging, web-based registries, computer-based decision support systems and multifaceted health professionals in the care team among others that are being tested to improve the quality of care for these diseases in high, middle and low-income countries. The goal of quality care for diabetes and hypertension demands innovation within the realities of health systems both in high as well as low and middle-income countries.

Keywords::

• chronic disease care
• diabetes
• high income countries
• hypertension
• low and middle income countries
• primary health care

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Diabetes and hypertension require multidisciplinary, continued and sustained, patient-centered care in a culturally and financially accessible setting such as primary care.

• The challenge before health systems in high-, low- and middle-income countries is not in the lack of appropriate drugs but in the delivery of health care for chronic diseases. The chronic care model is a useful framework that describes the essential elements of health care delivery for chronic care.

• The landscape of primary health care in high versus low- and middle-income countries is vastly different with differing challenges.

• Team care approach that shifts the primary caregiving task from a physician-centered model to involving other health professionals is essential to improved care.

• Innovations such as telephone messaging, telemonitoring, use of web-based registries, clinical decision support systems among others make health systems more patient centered, efficient and cost–effective, providing contextually relevant solutions for improved care in high-, low- and middle-income countries.

• Implementation research is required to bridge the gap between evidence and the realities of health systems in low- and middle-income countries.