Public health service options for affordable and accessible noncommunicable disease and related chronic disease prevention and management

Figures & data

Table 1 Nurse-led primary health care services

Service example	Key features and evaluated impact
True Blue model of collaborative care (Australia)	Practice nurses used as case managers for depression in tandem with management services for diabetes and heart disease. RCT shows the model:
	• Can contribute to improvements in diabetes, reduced 10-year cardiovascular risk, and improved depression.
	• Can be effectively introduced within general practice workforce settings.^Citation47
Community Outreach and Cardiovascular Health (COACH) trial (Baltimore, USA)	The trial utilized nurses as case managers to coordinate multicondition, collaborative care interventions. Results report:
	• Significantly improved outcomes in chronic disease management services led by nurses.
	• Risk factors such as total cholesterol, blood pressure, glycated hemoglobin levels, and low-density lipoprotein cholesterol were improved.
	• Patients in the team approach group reported significantly higher levels of satisfaction with chronic disease services.^Citation48,Citation49
Nurse-led disease management program for chronic kidney disease (RCT) (Hong Kong)	Model of chronic disease management utilizing a mix of specialist and generalist nurses. Results include:
	• Improvement in quality of life and satisfaction with care.
	• Improvement in nonadherence.^Citation50

Abbreviations: COACH, Community Outreach and Cardiovascular Health; RCT, randomized controlled trial; USA, United States of America.

Table 2 Allied health-led primary health care services

Service example	Key features and evaluated impact
Diabetes Prevention Program (DPP) (USA)	A comprehensive model designed to enhance the DPP was effective and successful in reducing diabetes and cardiovascular risk in high-risk individuals.
	• Utilized combined workshops to train health professionals in the fundamentals of DPP design and delivery.
	• Included social workers, exercise specialists, pharmacists, dietitians, registered nurses, psychologists, and others.
	• Program delivered in multiple settings, including primary care practice settings, churches, YMCAs, and health care locales.^Citation51
Capricornia Allied Health Partnership (Rockhampton, Queensland, Australia)	A team of allied health professionals provided services to clients with significant chronic disease challenges using a student assisted-clinic model.
	• Students and clinical staff from the professions of dietetics, nutrition, exercise physiology, pharmacy, podiatry, occupational therapy, and social work were included in the clinic.
	• This model of care attracted widespread interest, which led to the development and publication of a “how-to” guide for others seeking to replicate a similar model.^Citation40,Citation52

Abbreviations: DPP, Diabetes Prevention Program; USA, United States of America; YMCA, Young Men’s Christian Association.

Table 3 Student-led and student-assisted primary health care services

Service example	Key features and evaluated impact
Faculty of Health student-led clinics (Australia)	Student-led clinics delivering a broad range of urban and mobile rural allied health services.
	• Students supervised by highly qualified and clinically current physiotherapy, psychology, nutrition, nursing, midwifery, exercise physiology, and professional supervisors.
	• This provides health services to otherwise underserved populations while also allowing students to gain valuable clinical experience.^Citation53
Academic nurse clinics or “health stations” (Finland)	Academic nurse clinics or “health stations” have a dual aim of providing quality health care to vulnerable and low-income populations while also providing valuable learning experiences for nursing students.
	• Initial evaluations indicate that health stations provide a valuable service to local populations.
	• Future evaluations are intended to explore more specific health outcomes.^Citation54
Student-led disability services (Malaysia)	A community-based rehabilitation approach used to promote and achieve equality of access for people with disability, in this case, speech-language disability.
	• Implementation of student-led disability services in Malaysia provided an innovative way in benefitting both the community and students.
	• Student learning is enriched through contextually based instruction.^Citation55
Student-led rural health fairs (Southeastern USA)	Many residents in rural communities across the Southeastern USA have decreased access to health care. This example shows how 1,694 individual patients received health care from medical students via student-led rural health fairs.
	• Access to health care was a significant issue; many of the patients lacked a primary care provider (46%) and many did not have a health insurer (43%).
	• This intervention not only provided services to otherwise unserved populations, but also provided unique and invaluable student clinical learning experiences.^Citation56

Abbreviation: USA, United States of America.

Table 4 Community-led primary health care services

Service example	Key features and evaluated impact
Healthy living partnership and lifestyle weight-loss programs (North Carolina, USA)	Reports the effectiveness of primary health delivered by community health workers through well-established community health networks.
	The associated RCT supports the use of lay personnel in the delivery of community-based initiatives for the prevention and management of diabetes.^Citation57
Weight loss interventions for rural seniors (Arkansas, USA)	The use of lay health educators to implement weight loss interventions for rural seniors offers a viable model for the implementation of evidence-based obesity treatments to otherwise underserved populations.^Citation58,Citation59
Collaborative stepped-care intervention for people with depressive and anxiety disorders (Goa, India)	Depression and anxiety disorders are common worldwide. A case management and psychosocial intervention delivered by trained lay health counselors supplemented by medication provided by primary care physicians with supervision by a mental health specialist was evaluated utilizing a cluster RCT.
	Results indicated higher rate of recovery in the intervention group compared with the control group.^Citation60

Abbreviations: RCT, randomized controlled trial; USA, United States of America.

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