PurposeThe purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient “educational chain”. In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers.MethodsA total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers.ResultsBetween 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities – including owning and using a glucometer and belonging to a disease support group – saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63–68 mmol/mol) (P<0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) (P<0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous “links” of the educational chain.ConclusionOnline CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD’s, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country.

Since 2003, the Lilly Foundation has supported the noncommercial Lilly MDR-TB Partnership, which involves more than 45 local, national, global, and nongovernmental organizations and governments. The aim of the Lilly MDR-TB Partnership is to achieve significant global impact on multidrug-resistant tuberculosis (MDR-TB) by addressing a series of important local health care needs in highly affected countries: China, India, Russia, and South Africa. The main focus of activities during 2012–2016 was on community needs in primary care. Supported projects seek to make meaningful and measurable progress toward global and national TB objectives. The partnership programs share an overall conceptual approach known as “research, report, advocate”, based on the piloting of novel approaches on a small scale, with outcomes assessed at early stages. The results are analyzed and communicated to governments, health-policy experts, and local and national stakeholders, including those in other countries facing similar MDR-TB challenges. For successful, cost-effective initiatives, the analysis is used as support when advocating for the scaling up of initiatives to regional or national levels. This article discusses representative examples of projects supported by the Lilly MDR-TB Partnership in the time period 2012–2016. The examples illustrate the potential for globally informed, locally designed primary-care collaborations to strengthen health care systems and support TB policies and offer observations to inform future health care public–private partnerships.

Access within health care is a universal concern, independent of country income levels or the percentage of gross domestic product investment in health. Addressing the ongoing COVID-19 pandemic has shed light on the hidden access challenges across systems that present barriers to care for many people. These include cultural and language barriers, diminished trust in the health system, and lack of familiarity with negotiating care. 1 Although innovation has addressed certain barriers such as eliminating up-front costs during the pandemic, we still see immense hurdles to care. 1 In addition to participation barriers, staffing constraints, fragmentation of care, and uneven distribution of resources can pose significant obstacles. 2,3 A recent commentary in Communications Medicine emphasized that access to cancer care is dependent on ensuring the presence of staff, stuff, space, systems, and social support, 3 a concept coined by one of the leading architects of improving access, Paul Farmer.For example, screening and diagnosis initiatives for breast cancer are critical to identify cancers in early stages when there is more opportunity to improve outcomes and at lower cost to the health system. 4,5 However, screening programs can only succeed if subsequent diagnosis is confirmed and treatment is initiated within appropriate timelines. 4,6 This cannot occur if the system lacks the capacity in terms of resources, staffing, knowledge, or diagnostic capabilities to confirm diagnosis and refer the patient for care. Another challenge occurs when efforts to address access are implemented with a focus on speed and quantity rather than on quality of care. The Lancet Commission on High Quality Health in the SDG Era has warned that poor quality care is now a bigger barrier to reducing mortality in low-and middle-income countries than insufficient access. 7 Licensed under the Creative Commons Attribution 4.0 License 1