Improving primary care for diabetes and hypertension: findings from implementation research in rural South India
Background Chronic conditions are a leading cause of death and disability worldwide. Low-income and middle-income countries such as India bear a significant proportion of this global burden. Redesigning primary care from an acute-care model to a model that facilitates chronic care is a challenge and...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/12/e040271.full |
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| author | Bart Criel Nora Engel Dorothy Lall Prashanth N Srinivasan Narayanan Devadasan Klasien Horstman |
| author_facet | Bart Criel Nora Engel Dorothy Lall Prashanth N Srinivasan Narayanan Devadasan Klasien Horstman |
| author_sort | Bart Criel |
| collection | DOAJ |
| description | Background Chronic conditions are a leading cause of death and disability worldwide. Low-income and middle-income countries such as India bear a significant proportion of this global burden. Redesigning primary care from an acute-care model to a model that facilitates chronic care is a challenge and requires interventions at multiple levels.Objectives In this intervention study, we aimed to strengthen primary care for diabetes and hypertension at publicly funded primary healthcare centres (PHCs) in rural South India.Design and methods The complexities of transforming the delivery of primary care motivated us to use a ‘theory of change’ approach to design, implement and evaluate the interventions. We used both quantitative and qualitative data collection methods. Data from patient records regarding processes of care, glycaemic and blood pressure control, interviews with patients, observations and field notes were used to analyse what changes occurred and why.Interventions We implemented the interventions for 9 months at three PHCs: (1) rationalise workflow to include essential tasks like counselling and measurement of blood pressure/blood glucose at each visit; (2) distribute clinical tasks among staff; (3) retain clinical records at the health facility and (4) capacity building of staff.Results We found that interventions were implemented at all three PHCs for the first 4 months but did not continue at two of the PHCs. This fadeout was most likely the result of staff transfers and a doctor’s reluctance to share tasks. The availability of an additional staff member in the role of a coordinator most likely influenced the relative success of implementation at one PHC.Conclusion These findings draw attention to the need for building teams in primary care for managing chronic conditions. The role of a coordinator emerged as an important consideration, as did the need for a stable core of staff to provide continuity of care. |
| format | Article |
| id | doaj-art-66af66ca8a8e401cbed22ad8d2c2e1ac |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-66af66ca8a8e401cbed22ad8d2c2e1ac2024-11-21T22:40:10ZengBMJ Publishing GroupBMJ Open2044-60552020-12-01101210.1136/bmjopen-2020-040271Improving primary care for diabetes and hypertension: findings from implementation research in rural South IndiaBart Criel0Nora Engel1Dorothy Lall2Prashanth N Srinivasan3Narayanan Devadasan4Klasien Horstman5Department of Public Health, Institute of Tropical Medicine, Antwerp, BelgiumDepartment of Health, Ethics & Society/CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The NetherlandsHealth Services, Institute of Public Health Bengaluru, Bangalore, Karnataka, IndiaHealth Equity Research, Institute of Public Health Bengaluru, Bangalore, Karnataka, IndiaPrimary Care, Health Systems Transformation Platform, New Delhi, IndiaCAPHRI Care and Public Health Research Institute, Faculty of Health and Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The NetherlandsBackground Chronic conditions are a leading cause of death and disability worldwide. Low-income and middle-income countries such as India bear a significant proportion of this global burden. Redesigning primary care from an acute-care model to a model that facilitates chronic care is a challenge and requires interventions at multiple levels.Objectives In this intervention study, we aimed to strengthen primary care for diabetes and hypertension at publicly funded primary healthcare centres (PHCs) in rural South India.Design and methods The complexities of transforming the delivery of primary care motivated us to use a ‘theory of change’ approach to design, implement and evaluate the interventions. We used both quantitative and qualitative data collection methods. Data from patient records regarding processes of care, glycaemic and blood pressure control, interviews with patients, observations and field notes were used to analyse what changes occurred and why.Interventions We implemented the interventions for 9 months at three PHCs: (1) rationalise workflow to include essential tasks like counselling and measurement of blood pressure/blood glucose at each visit; (2) distribute clinical tasks among staff; (3) retain clinical records at the health facility and (4) capacity building of staff.Results We found that interventions were implemented at all three PHCs for the first 4 months but did not continue at two of the PHCs. This fadeout was most likely the result of staff transfers and a doctor’s reluctance to share tasks. The availability of an additional staff member in the role of a coordinator most likely influenced the relative success of implementation at one PHC.Conclusion These findings draw attention to the need for building teams in primary care for managing chronic conditions. The role of a coordinator emerged as an important consideration, as did the need for a stable core of staff to provide continuity of care.https://bmjopen.bmj.com/content/10/12/e040271.full |
| spellingShingle | Bart Criel Nora Engel Dorothy Lall Prashanth N Srinivasan Narayanan Devadasan Klasien Horstman Improving primary care for diabetes and hypertension: findings from implementation research in rural South India BMJ Open |
| title | Improving primary care for diabetes and hypertension: findings from implementation research in rural South India |
| title_full | Improving primary care for diabetes and hypertension: findings from implementation research in rural South India |
| title_fullStr | Improving primary care for diabetes and hypertension: findings from implementation research in rural South India |
| title_full_unstemmed | Improving primary care for diabetes and hypertension: findings from implementation research in rural South India |
| title_short | Improving primary care for diabetes and hypertension: findings from implementation research in rural South India |
| title_sort | improving primary care for diabetes and hypertension findings from implementation research in rural south india |
| url | https://bmjopen.bmj.com/content/10/12/e040271.full |
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