Innovations in Community-Based Health Care for Cardiometabolic Diseases
Authors: Rohina Joshi, Andre Pascal Kengne, Fred Hersch, Mary Beth Weber, Helen McGuire, Anushka Patel
Cardiometabolic diseases disproportionately affect low and middle income countries (LMIC) where nearly 80% of cardiometabolic disease related deaths occur. These diseases occur at a much younger age in LMIC contributing to greater loss of potential years of healthy life. With the acute shortage and mal-distribution of the health workforce in LMIC, achieving better health outcomes for the prevention and control of cardiometabolic diseases is a major challenge. This chapter reviews two innovative strategies of prevention and management of diseases, namely task-shifting (shifting some aspects of health care management to non-physicians) and self-management (enabling patients to manage symptoms, treatment and lifestyle changes associated with disease).
Our review suggests that task-shifting and self-management initiatives for cardiometabolic diseases in LMIC can be effective strategies, with some (although often poor quality) evidence of improved health outcomes such as reductions in blood pressure and blood glucose levels, increased uptake of medications and improvement in lifestyle behaviours. While there is accumulating evidence from intervention research to support both these strategies, little is known about components of those interventions that work the best, and there are large evidence gaps in how to translate the successful findings from research settings into real life. Operational research is needed to understand issues relating to the effectiveness and cost-effectiveness of these strategies and the quality of care provided, patient acceptability and importantly, given likely concerns over safety and effectiveness health outcomes.