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Chronic Disease Prevention and Management in Primary Health Care

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 39179

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Special Issue Editors

Dr. Woldesellassie M. Bezabhe

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Guest Editor

School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, TAS 7001, Australia
Interests: medication safety; quality use of medicine; management of chronic disease; atrial fibrillation; chronic kidney disease; dementia

Dr. Wubshet Tesfaye

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Guest Editor

1. School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
2. School of Medicine, College of Health and Medicine, University of Tasmania, Sandy Bay, TAS 7005, Australia
3. Faculty of Health, University of Canberra, Bruce, Canberra, ACT 2617, Australia
Interests: chronic kidney disease; medication appropriateness index; medication regimen complexity index; the elderly
Special Issues, Collections and Topics in MDPI journals

Dr. Alemayehu B Mekonnen

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Guest Editor

Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne 3217, Australia
Interests: quality use of medicines; aged care; evidence-based healthcare; cardiovascular diseases

Special Issue Information

Dear Colleagues,

The global burden of chronic disease is increasing rapidly. According to the World Health Organization, by the end of this year, chronic disease will have accounted for 73% of all deaths and 60% of the global burden of disease. Primary Health Care (PHC) is well placed to decrease this burden through the delivery of care that focuses on the prevention and management of risk factors, such as high blood pressure, a high level of cholesterol, and smoking. The defining features of PHC, including continuity, coordination, and comprehensiveness, make it an ideal setting for the prevention and management of the chronic disease. There is a growing realization that care for chronic disease becomes more effective when a multidisciplinary and complementary approach is taken. However, there are several barriers for PHC to overcome in order to function to its full potential, and its strength varies across the globe. For instance, countries that use a proactive PHC system tend to have better health outcomes with minimal cost. The appropriate and cost-effective response of PHC to manage and prevent chronic disease requires new evidence that highlights approaches to reorienting health policy and healthcare. For this Special Issue, we invite the submission of papers that identify gaps in chronic disease prevention and management, including primary care models and interventions.

Dr. Woldesellassie M. Bezabhe
Dr. Wubshet Tesfaye
Dr. Alemayehu B Mekonnen
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

primary care
chronic disease
chronic disease management
chronic care
chronic disease prevention
cardiovascular disease
chronic care model
multidisciplinary team
team care
medication safety

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Published Papers (11 papers)

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Research

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18 pages, 701 KiB

Open AccessArticle

Time-to-Treatment Initiation in a Decentralised Community-Care Model of Drug-Resistant Tuberculosis Management in the OR Tambo District Municipality of South Africa

by Joshua Oise Iruedo and Michael K. Pather

Int. J. Environ. Res. Public Health 2023, 20(14), 6423; https://doi.org/10.3390/ijerph20146423 - 21 Jul 2023

Cited by 1 | Viewed by 1650

Abstract

Background: Drug-resistant tuberculosis (DR-TB) continues to challenge global efforts toward eradicating and having a tuberculosis-free world. Considering the high early mortality, especially among HIV-infected individuals, early diagnosis and prompt initiation of effective treatment are needed to significantly reduce mortality and halt transmission of DR-TB in the community. Aim: This study aims to assess the effectiveness of a community DR-TB care model with the specific objective of determining the Time-to-treatment initiation of DR-TB among patients in the OR Tambo district municipality. Methods: A prospective cohort study of patients with DR-TB was conducted in the OR Tambo district municipality of Eastern Cape Province, South Africa. Patients were enrolled as they presented for treatment initiation at the decentralised facilities following a diagnosis of DR-TB and compared with a centralised site. Results: A total of 454 DR-TB patients from six facilities between 2018 and 2020 were included in the analysis. The mean age was 37.54 (SD = 14.94) years. There were slightly more males (56.2%) than females (43.8%). Most of the patients were aged 18–44 years (67.5%), without income (82.3%). Results showed that slightly over thirteen percent (13.4%) of patients initiated treatment the same day they were diagnosed with DR-TB, while 36.3% were on the time-to-treatment target of being initiated within 5 days. However, about a quarter (25.8%) of patients failed to initiate treatment two weeks after diagnosis. Time-to-treatment initiation (TTTI) varied according to the decentralised sites, with progressive improvement with each successive year between 2018 and 2021. No demographic factor was significantly associated with TTTI. Conclusion: Despite rapid diagnosis, only 36% of patients were initiated on treatment promptly. Operational challenges remained, and services needed to be reorganised to maximise the exceptional potentials that a decentralised community DR-TB care model brings. Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

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21 pages, 931 KiB

Open AccessArticle

“To Be Treated as a Person and Not as a Disease Entity”—Expectations of People with Visual Impairments towards Primary Healthcare: Results of the Mixed-Method Survey in Poland

by Katarzyna Weronika Binder-Olibrowska, Maciek Godycki-Ćwirko and Magdalena Agnieszka Wrzesińska

Int. J. Environ. Res. Public Health 2022, 19(20), 13519; https://doi.org/10.3390/ijerph192013519 - 19 Oct 2022

Cited by 3 | Viewed by 2894

Abstract

Primary care is the core part of the Polish healthcare system. Improving its quality for vulnerable populations is among the principal goals of global and national health policies. Identifying patients’ needs is critical in this process. People who are blind or have low vision often demonstrate comorbidities and require more specific healthcare. The aim of this study was to explore the needs of Polish persons with visual impairments when they use primary care services. 219 respondents answered the “Patient value” questionnaire from the project Quality and Costs of Primary Care in Europe (QUALICOPC) and an open question regarding additional patients’ needs. Statistical and content analyses were used. The expectations of the study group regarding primary care appeared to be higher than those described in studies among other populations. Equity and accessibility were the most valued dimensions of care. Among particular aspects of care, those connected with psychosocial competencies and awareness of disability among medical staff appeared most frequently. Some personal characteristics were associated with preferences, including age, gender, longstanding conditions, quality of life, and disability-related variables. Our study indicates a need for multilevel interventions in legislation, economics, and medical staff training, with the people-centered approach as the option maximizing chances to meet diverse healthcare needs arising from particular disabilities. Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

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13 pages, 7790 KiB

Open AccessArticle

Developing a Personalized Integrative Obesity-Coaching Program: A Systems Health Perspective

by Sander M. Brink, Heleen M. Wortelboer, Cornelis H. Emmelot, Tommy L. S. Visscher and Herman A. van Wietmarschen

Int. J. Environ. Res. Public Health 2022, 19(2), 882; https://doi.org/10.3390/ijerph19020882 - 13 Jan 2022

Cited by 2 | Viewed by 2734

Abstract

Current obesity management strategies are failing to achieve sustainable and favorable long-term results. We propose a more personalized, dynamic, and systemic perspective on the interactions of key determinants and coaching advice on obesity. The aim of this study was to use a systems view on overweight, complexity science, and a transdisciplinary process to develop a five-year personalized integrative obesity-coaching and research program. Managers, medical specialists, clinical psychologists, dieticians, physical- and psychomotor therapists, and lifestyle coaches aligned their perspectives and objectives with experts in systems thinking and systems biology. A systems health model of obesity was used to identify the causal relations of variables with the most influence on obesity. The model helped to align and design a personalized integrative obesity-coaching program and to identify the key variables to monitor the progress and to adjust the personalized program, depending on the goals and needs of the participant. It was decided to use subtyping of participants by a systems biologist, based on traditional Chinese medicine symptoms, as a novel method to personalize the intervention. The collaborative transdisciplinary approach based upon a systems view on obesity was successful in developing a personalized and adaptive five-year obesity-coaching and research program. Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

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14 pages, 349 KiB

Open AccessArticle

Family Physician’s and Primary Care Team’s Perspectives on Supporting Family Caregivers in Primary Care Networks

by Jasneet Parmar, Sharon Anderson, Marjan Abbasi, Saeed Ahmadinejad, Karenn Chan, Lesley Charles, Bonnie Dobbs, Amandeep Sheny Khera, Jennifer Stickney-Lee, Peter George J. Tian and Suvidha Jain

Int. J. Environ. Res. Public Health 2021, 18(6), 3293; https://doi.org/10.3390/ijerph18063293 - 23 Mar 2021

Cited by 15 | Viewed by 4417

Abstract

Background. Research, practice, and policy have focused on educating family caregivers to sustain care but failed to equip healthcare providers to effectively support family caregivers. Family physicians are well-positioned to care for family caregivers. Methods. We adopted an interpretive description design to explore family physicians and primary care team members’ perceptions of their current and recommended practices for supporting family caregivers. We conducted focus groups with family physicians and their primary care team members. Results. Ten physicians and 42 team members participated. We identified three major themes. “Family physicians and primary care teams can be a valuable source of support for family caregivers” highlighted these primary care team members’ broad recognition of the need to support family caregiver’s health. “What stands in the way” spoke to the barriers in current practices that precluded supporting family caregivers. Primary care teams recommended, “A structured approach may be a way forward.” Conclusion. A plethora of research and policy documents recommend proactive, consistent support for family caregivers, yet comprehensive caregiver support policy remains elusive. The continuity of care makes primary care an ideal setting to support family caregivers. Now policy-makers must develop consistent protocols to assess, and care for family caregivers in primary care. Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

13 pages, 556 KiB

Open AccessArticle

Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

by Chuan De Foo, Shilpa Surendran, Geronimo Jimenez, John Pastor Ansah, David Bruce Matchar and Gerald Choon Huat Koh

Int. J. Environ. Res. Public Health 2021, 18(6), 2926; https://doi.org/10.3390/ijerph18062926 - 12 Mar 2021

Cited by 12 | Viewed by 5298

Abstract

The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN’s face in chronic disease management. The objective of this study is to map features of PCN to Starfield’s “4Cs” framework. The “4Cs” of primary care—comprehensiveness, first contact access, coordination and continuity—offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN’s empowering features that fulfil the “4Cs”. On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the “4Cs”. However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management. Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

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11 pages, 322 KiB

Open AccessArticle

The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context

by Shilpa Surendran, Chuan De Foo, Chen Hee Tam, Elaine Qiao Ying Ho, David Bruce Matchar, Josip Car and Gerald Choon Huat Koh

Int. J. Environ. Res. Public Health 2021, 18(4), 1817; https://doi.org/10.3390/ijerph18041817 - 13 Feb 2021

Cited by 10 | Viewed by 3081

Abstract

In recent years, there is growing interest internationally to implement patient-centered medical homes (PCMHs), and Singapore is no exception. However, studies understanding the influence of contextual policy factors on the implementation of PCMHs are limited. We conducted 10 semi-structured in-depth interviews with general practitioners working in seven out of the nine PCMHs. Audio recordings were transcribed and analyzed by two study team members in NVivo 12 Software using grounded theory techniques. Power dynamics between the stakeholders and lack of shared decision-making among them in selecting the locale of the PCMH and formulating the practice fee and pharmacy structure were the key factors which negatively affected the implementation of PCMHs on a larger scale. Over time, lack of funding to hire dedicated staff to transfer patients and misalignment of various stakeholders’ interest to other right-siting programs also resulted in low number of patients with chronic conditions and revenue. Countries seeking to implement a successful PCMH may benefit from building trust and relationship between stakeholders, engaging in shared decision-making, ongoing cost-efficiency efforts, and formulating a clear delineation of responsibilities between stakeholders. For a healthcare delivery model to succeed in the primary care landscape, policies should be developed keeping mind the realities of primary care practice. Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

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15 pages, 2416 KiB

Open AccessReview

Prevalence, Awareness, Treatment, and Control of Hypertension in the United Arab Emirates: A Systematic Review and Meta-Analysis

by Akshaya Srikanth Bhagavathula, Syed Mahboob Shah and Elhadi Husein Aburawi

Int. J. Environ. Res. Public Health 2021, 18(23), 12693; https://doi.org/10.3390/ijerph182312693 - 2 Dec 2021

Cited by 11 | Viewed by 4130

Abstract

Background: Evidence for the prevalence, awareness, treatment, and control of hypertension in the United Arab Emirates (UAE) is limited. A systematic review and meta-analysis were conducted to summarize the existing knowledge regarding the prevalence, awareness, treatment, and control of hypertension in the UAE. Methods: We searched PubMed/MEDLINE, Embase, Scopus, and Google Scholar using prespecified medical subject handling (MeSH) terms and text words to identify the relevant published articles from 1 January 1995 to 31 August 2021. Population-based prospective observational studies conducted among healthy adult subjects living in the UAE and that defined hypertension using the guidelines-recommended blood pressure (BP) cut-offs ≥ 130/80 mmHg or ≥ 140/90 mmHg were considered. Results: Of 1038 studies, fifteen cross-sectional studies were included for data extraction involving 139,907 adults with a sample size ranging from 74 to 50,138 and with cases defined as blood pressure ≥ 140/90 mmHg. The pooled prevalence of hypertension was 31% (95% confidence interval (CI): 27–36), and a higher prevalence was observed in Dubai (37%, 95% CI: 28–45) than in the Abu Dhabi region (29%, 95% CI: 24–35) and in multicenter studies (24%, 95% CI: 14–33). The level of awareness was only 29% (95% CI: 17–42), 31% (95% CI: 18–44) for treatment, and 38% (95% CI: 19–57) had controlled BP (< 140/90 mmHg). Conclusion: This study revealed a high prevalence of hypertension with low awareness and suboptimal control of hypertension. Multifaceted approaches that include the systematic measurement of BP, raising awareness, and improving hypertension diagnoses and treatments are needed. Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

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13 pages, 472 KiB

Open AccessReview

Patient-Centered Self-Management in Patients with Chronic Kidney Disease: Challenges and Implications

by Chiu-Chu Lin and Shang-Jyh Hwang

Int. J. Environ. Res. Public Health 2020, 17(24), 9443; https://doi.org/10.3390/ijerph17249443 - 16 Dec 2020

Cited by 22 | Viewed by 6571

Abstract

This review aims to identify attributes of patient-centered self-management (PCSM) in the current literature and explore its implementation in resolving patient obstacles in chronic kidney disease (CKD) treatment and management. A search of relevant articles and literature on PCSM, integrated care, and challenges of CKD management was conducted. Vital attributes of PCSM and current self-management interventions employed to resolve patient obstacles in CKD management were identified from inclusion studies. Findings affirm that PCSM strategies have positive effects on CKD management, but a lack of quality primary study, and long-term evidence presents the need for further development. Future research should focus on the development of a standardized and universal integrated PCSM model and a uniform system of data collection in the clinical setting. The difficulty of CKD management lies in how it is a comorbid and progressive disease. A pure biomedical approach is inadequate. Our review recommends that an integrated PCSM approach with health literacy and information technology intervention, which unifies and integrates patient education, can address the difficulties that are contributing to unsuccessful treatment outcomes. An integrated PCSM model should be implemented systematically and methodologically into future CKD management and health policies. Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

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2 pages, 241 KiB

Open AccessReply

Reply to Ngoh et al. Comment on “Surendran et al. The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context. Int. J. Environ. Res. Public Health 2021, 18, 1817”

by Shilpa Surendran, Chuan De Foo, Chen Hee Tam, Elaine Qiao Ying Ho, David Bruce Matchar, Josip Car and Gerald Choon Huat Koh

Int. J. Environ. Res. Public Health 2022, 19(8), 4686; https://doi.org/10.3390/ijerph19084686 - 13 Apr 2022

Cited by 2 | Viewed by 1151

Abstract

We carefully read the comment [...] Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

4 pages, 262 KiB

Open AccessComment

Comment on Surendran et al. The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context. Int. J. Environ. Res. Public Health 2021, 18, 1817

by Sharon Ngoh, Wern Ee Tang, Edwin Chng and Phui-Nah Chong

Int. J. Environ. Res. Public Health 2022, 19(8), 4683; https://doi.org/10.3390/ijerph19084683 - 13 Apr 2022

Cited by 2 | Viewed by 1470

Abstract

We have noted the views expressed by the authors of the article “The Missed Opportunity of Patient-Centered Medical Homes (PCMH) to Thrive in an Asian Context” by Surendran et al. [...] Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

14 pages, 361 KiB

Open AccessStudy Protocol

Evaluation of General Practice Pharmacists: Study Protocol to Assess Interprofessional Collaboration and Team Effectiveness

by Thilini Sudeshika, Mark Naunton, Gregory M. Peterson, Louise S. Deeks, Jackson Thomas and Sam Kosari

Int. J. Environ. Res. Public Health 2021, 18(3), 966; https://doi.org/10.3390/ijerph18030966 - 22 Jan 2021

Cited by 3 | Viewed by 3078

Abstract

The inclusion of pharmacists into general practices has expanded in Australia. However, there is a paucity of research examining interprofessional collaboration and team effectiveness after including a pharmacist into the general practice team in primary or community care. This is a protocol for a cross-national comparative mixed-methods study to (i) investigate interprofessional collaboration and team effectiveness within the general practice team after employing pharmacists in general practices in the Australian Capital Territory (ACT) and (ii) to compare interprofessional collaboration and team effectiveness of pharmacists in general practice across Australia with international sites. The first objective will be addressed through a multiphase sequential explanatory mixed-method design, using surveys and semi-structured interviews. The study will recruit general practice pharmacists, general practitioners, and other health professionals from eight general practices in the ACT. Quantitative and qualitative results will be merged during interpretation to provide complementary perspectives of interprofessional collaboration. Secondly, a quantitative descriptive design will compare findings on interprofessional collaboration (professional interactions, relationship initiation, exchange characteristics, and commitment to collaboration) and team effectiveness of general practice pharmacists in Australia with international sites from Canada and the United Kingdom. The results of the study will be used to provide recommendations on how to best implement the role of general practice pharmacists across Australia. Full article

(This article belongs to the Special Issue Chronic Disease Prevention and Management in Primary Health Care)

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