Integrated approaches to prevention and control of chronic conditions

Integrated approaches to prevention and control of chronic conditions. Chronic conditions currently account for more than 50% of the global disease burden, and this figure is projected to continue to rise. Yet, around the world, health care systems are not organized to provide effective and efficient care for chronic health problems. Health care systems have evolved around the concept of acute, infectious disease, and they perform best when addressing patients' acute and urgent symptoms. Without change, health care systems will grow increasingly inefficient and ineffective. Effective prevention, management, and rehabilitation of chronic conditions require an evolution of health care, away from a model that is focused on acute symptoms toward a coordinated, comprehensive system of care. The results of this shift include less waste and improved efficiency. Integrated health care models that transcend specific illnesses provide a feasible solution. The World Health Organization's Innovative Care for Chronic Conditions Framework provides a flexible but comprehensive model to build or redesign health systems in accord with local resources and demands

Community-based control of a neglected tropical disease: the mossy foot treatment and prevention association

Podoconiosis (endemic non-filarial elephantiasis, also known as mossy foot) is a non-communicable disease now found exclusively in the tropics, caused by the conjunction of environmental, genetic, and economic factors. Silicate particles formed by the disintegration of lava in areas of high altitude (over 1,000 m) and seasonal rainfall (over 1,000 mm per annum) penetrate the skin of barefoot subsistence farmers, and in susceptible individuals cause lymphatic blockage and subsequent elephantiasis [1]. Although an estimated one million Ethiopians (of a total population of 77 million) are afflicted with podoconiosis [2], which creates a huge economic burden in endemic areas [3], no national policy has yet been developed to control or prevent the condition, and most affected communities remain unaware of treatment options

Predicting outcome in acute low back pain using different models of patient profiling

This is a non-final version of an article published in final form in Spine, 34(18), 1970 - 1975, 2009. Copyright © 2009 Lippincott Williams & Wilkins, Inc.Study Design. Prospective observational study of prognostic indicators, using data from a randomized, controlled trial of physiotherapy care of acute low back pain (ALBP) with follow-up at 6 weeks, 3 months, and 6 months. Objective. To evaluate which patient profile offers the most useful guide to long-term outcome in ALBP. Summary of Background Data. The evidence used to inform prognostic decision-making is derived largely from studies where baseline data are used to predict future status. Clinicians often see patients on multiple occasions so may profile patients in a variety of ways. It is worth considering if better prognostic decisions can be made from alternative profiles. Methods. Clinical, psychological, and demographic data were collected from a sample of 54 ALBP patients. Three clinical profiles were developed from information collected at baseline, information collected at 6 weeks, and the change in status between these 2 time points. A series of regression models were used to determine the independent and relative contributions of these profiles to the prediction of chronic pain and disability. Results. The baseline profile predicted long-term pain only. The 6-week profile predicted both long-term pain and disability. The change profile only predicted long-term disability (P 0.05). A similar result was obtained when the order of entry was reversed. When predicting long-term disability, after the 6-week profile was entered at the first step, the change profile was not significant when forced in at the second step. However, when the change profile was entered at the first step and the 6-week clinical profile was forced in at the second step, a significant contribution of the 6-week profile was found. Conclusion. The profile derived from information collected at 6 weeks provided the best guide to long-term pain and disability. The baseline profile and change in status offered less predictive value

Frequent consulting and multiple morbidity: a qualitative comparison of ‘high’ and ‘low’ consulters of GPs

Background. Frequent consulting is associated with multiple and complex social and health conditions. It is not known how the impact of multiple conditions, the ability to self-manage and patient perception of the GP consultation combines to influence consulting frequency

Health promotion profile of youth sports clubs in Finland: club officials' and coaches' perceptions

The purpose of this article is to examine the current health promotion orientation of youth sports clubs in Finland in view of the standards created previously for the health promoting sports club (HPSC). Ninety-seven youth sports clubs participated, and 273 sports club officials and 240 coaches answered the questionnaires. To describe clubs health promotion orientations, an HPSC index was created. The HPSC index was formulated on sub-indices by factor analysis. The sub-indices were: policy, ideology, practice and environment indexes. The results indicate that youth sports clubs are fairly health promoting in general. On average, the clubs fulfilled 12 standards for HPSC out of 22. Every fourth club was categorized as higher health promoting (≥ 15 fulfilled standards), and every third as lower health promoting (<11 fulfilled standards). The variation between clubs was wide. The clubs that had been recognized as exemplary and hence certified by the Young Finland Association were more likely to recognize health promotion than non-certified clubs (OR = 2.36, p = 0.016). The sports club officials were twice as likely to evaluate their clubs as higher health promoting than the coaches (OR = 2.04, p = 0.041). Under the sub-indices, ideologies were recognized best, others less. These findings indicate that minority of the youth sports clubs have realized health promotion comprehensively as a part of their activities. There is a lot of need for development, especially in the area of health promotion policies and practices. The instruments used proved valid and reliable and can therefore be recommended for international use

Convergences and divergences of diabetic patients' and healthcare professionals' opinions of care : a qualitative study

OBJECTIVES: To investigate opinions' convergences and divergences of diabetic patients and health-care professionals on diabetes care and the development of a regional diabetes programme. BACKGROUND: Development and implementation of a regional diabetes programme. RESEARCH DESIGN: Qualitative study using focus groups to elicit diabetic patients' and health-care professionals' opinions, followed by content analysis. SETTING AND PARTICIPANTS: Eight focus groups: four focus groups with diabetic patients (n = 39) and four focus groups with various health-care professionals (n = 34) residing or practicing in the canton of Vaud, Switzerland, respectively. RESULTS: Perceived quality of diabetes care varied between individuals and types of participants. To improve quality, patients favoured a comprehensive follow-up while professionals suggested considering existing structures and trained professionals. All participants mentioned communication difficulties between professionals and were favouring teamwork. In addition, they described the role that patients should have in care and self-management. Financial difficulties were also mentioned by both groups of participants. Finally, they were in favour of the development of a regional diabetes programme adapted to actors' needs. For patients indeed, such a programme would represent an opportunity to improve information and to have access to comprehensive care. For professionals, it would help the development of local networks and the reinforcement of existing tools and structures. DISCUSSION AND CONCLUSIONS: Acknowledging convergences and divergences of opinions of both diabetic patients and health-care professionals should help the further development of a programme adapted to users' needs, taking all stakeholders interests and priorities into consideration

Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.

BACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care

Analysing NSW state policy for child obesity prevention: strategic policy versus practical action

There is increasing worldwide recognition of the need for government policies to address the recent increases in the incidence and prevalence of childhood obesity. The complexity and inter-relatedness of the determinants of obesity pose a genuine policy challenge, both scientifically and politically. This study examines the characteristics of one of the early policy responses, the NSW Government\u27s Prevention of Obesity in Children and Young People: NSW Government Action Plan 2003-2007 (GAP), as a case study, assessing it in terms of its content and capacity for implementation. This policy was designed as an initial set of practical actions spanning five government sectors. Most of the policy actions fitted with existing implementation systems within NSW government, and reflected an incremental approach to policy formulation and implementation. As a case study, the NSW Government Action Plan illustrates that childhood obesity policy development and implementation are at an early stage. This policy, while limited, may have built sufficient commitment and support to create momentum for more strategic policy in the future. A more sophisticated, comprehensive and strategic policy which can also be widely implemented and evaluated should now be built on this base