Primary healthcare reform for chronic conditions in countries with high or very high human development index: A systematic review

Abstract

Objective To address the growing burden of chronic disease globally, many countries have developed a national policy for primary healthcare reform. In some countries with high and very high human development index, evaluations of the implementation of these reforms have been published. To date, there has been no systematic review of these evaluations. The objectives of this review are to identify: (a) the vision for primary healthcare; (b) the features of primary healthcare reforms; and (c) evaluation findings of primary healthcare reforms. Methods A systematic literature review was conducted guided by the PRISMA statement. We searched for academic articles and grey literature from 1 March 2008 to 1 September 2020. Screening and data extraction were conducted by two authors. Descriptive analysis and narrative synthesis were applied. Results A vision for integrated primary healthcare shifting chronic disease management from specialist hospital services to primary care was found to require new organization and funding models such as collaborative primary healthcare networks and commissioning along with shared governance across health sectors. The need for general practitioner leadership and engagement to support primary healthcare reform was identified. Although there was evidence of barriers in progressing primary healthcare reform, evaluation results showed some positive outcomes, most notably shifts in services towards increased primary care access and utilization. Discussion A challenge in undertaking the review was the heterogeneity of articles with little consistency in how primary healthcare reform was evaluated and reported on across countries. Evaluation of national health reforms involves complex system-wide projects and is an area that needs further exploration and discussion to determine the most appropriate methodologies for collecting and analysing large-scale data with consideration for service and health outcomes.

Improving the health outcomes of individuals with chronic illness through the delivery of healthcare services

“…Assessments of the use of these advances have been published by several nations with high and extremely high human development indices. (18) Cohen et al (19) found several variables affecting the availability of evidence-based chronic illness therapy in primary care that meets guidelines.…”

National Chronic Disease Management Programmes in Irish General Practice-Preparedness and Challenges

“…General practice is the first point of contact for individual feeling ill in Irish health care system [ 1 ]. Structured general practice programmes for chronic disease management (CDM) have demonstrated benefits such as improved monitoring, better compliance and some improved outcomes [ 2 , 3 , 4 , 5 , 6 ]. Ireland’s Department of Health has identified structured care of chronic diseases in general practice as a core component of future health policy; in 2020 the Health Service Executive (HSE) established a CDM care system for general practice [ 7 , 8 ].…”