Journal Article > CommentaryFull Text
Health Aff (Millwood). 2015 September 1; Volume 34 (Issue 9); 1569-1577.; DOI:10.1377/hlthaff.2015.0375
Kishore SP, Kolappa K, Jarvis JN, Park PH, Belt R, et al.
Health Aff (Millwood). 2015 September 1; Volume 34 (Issue 9); 1569-1577.; DOI:10.1377/hlthaff.2015.0375
The modern access-to-medicines movement grew largely out of the civil-society reaction to the HIV/AIDS pandemic three decades ago. While the movement was successful with regard to HIV/AIDS medications, the increasingly urgent challenge to address access to medicines for noncommunicable diseases has lagged behind-and, in some cases, has been forgotten. In this article we first ask what causes the access gap with respect to lifesaving essential noncommunicable disease medicines and then what can be done to close the gap. Using the example of the push for access to antiretrovirals for HIV/AIDS patients for comparison, we highlight the problems of inadequate global financing and procurement for noncommunicable disease medications, intellectual property barriers and concerns raised by the pharmaceutical industry, and challenges to building stronger civil-society organizations and a patient and humanitarian response from the bottom up to demand treatment. We provide targeted policy recommendations, specific to the public sector, the private sector, and civil society, with the goal of improving access to noncommunicable disease medications globally.
Journal Article > CommentaryFull Text
Lancet Diabetes Endocrinol. 2019 August 1; DOI:10.1016/S2213-8587(19)30197-4.
Kehlenbrink S, Jaacks LM, Perone SA, Ansbro É, Ashbourne E, et al.
Lancet Diabetes Endocrinol. 2019 August 1; DOI:10.1016/S2213-8587(19)30197-4.
Journal Article > ResearchFull Text
Public Health Action. 2019 December 21; Volume 9 (Issue 4); DOI:10.5588/pha.19.0007
Ngoga G, Park PH, Borg R, Bukhman G, Ali E, et al.
Public Health Action. 2019 December 21; Volume 9 (Issue 4); DOI:10.5588/pha.19.0007
Setting:
Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda.
Objective:
To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home.
Design:
A retrospective descriptive cohort study using routinely collected data involving adult patients aged ⩾18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014.
Results:
Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs.
Conclusion:
By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.
Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda.
Objective:
To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home.
Design:
A retrospective descriptive cohort study using routinely collected data involving adult patients aged ⩾18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014.
Results:
Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs.
Conclusion:
By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.
Journal Article > ResearchFull Text
Public Health Action. 2017 September 21; Volume 7 (Issue 3); 231-236.; DOI:10.5588/pha.16.0130
Nyirandagijimana B, Edwards JK, Venables E, Ali E, Rusangwa C, et al.
Public Health Action. 2017 September 21; Volume 7 (Issue 3); 231-236.; DOI:10.5588/pha.16.0130
SETTING
Programmes that integrate mental health care into primary care settings could reduce the global burden of mental disorders by increasing treatment availability in resource-limited settings, including Rwanda.
OBJECTIVE
We describe patient demographics, service use and retention of patients in care at health centres (HC) participating in an innovative primary care integration programme, compared to patients using existing district hospital-based specialised out-patient care.
DESIGN
This was a retrospective cohort study using routinely collected data from six health centres and one district hospital from October 2014 to March 2015. Results: Of 709 patients, 607 were cared for at HCs; HCs accounted for 88% of the total visits for mental disorders. Patients with psychosis used HC services more frequently, while patients with affective disorders were seen more frequently at the district hospital. Of the 68% of patients who returned to care within 90 days of their first visit, 76% had a third visit within a further 90 days. There were no significant differences in follow-up rates between clinical settings.
CONCLUSION
This study suggests that a programme of mentorship for primary care nurses can facilitate the decentralisation of out-patient mental health care from specialised district hospital mental health services to HCs in rural Rwanda.
Programmes that integrate mental health care into primary care settings could reduce the global burden of mental disorders by increasing treatment availability in resource-limited settings, including Rwanda.
OBJECTIVE
We describe patient demographics, service use and retention of patients in care at health centres (HC) participating in an innovative primary care integration programme, compared to patients using existing district hospital-based specialised out-patient care.
DESIGN
This was a retrospective cohort study using routinely collected data from six health centres and one district hospital from October 2014 to March 2015. Results: Of 709 patients, 607 were cared for at HCs; HCs accounted for 88% of the total visits for mental disorders. Patients with psychosis used HC services more frequently, while patients with affective disorders were seen more frequently at the district hospital. Of the 68% of patients who returned to care within 90 days of their first visit, 76% had a third visit within a further 90 days. There were no significant differences in follow-up rates between clinical settings.
CONCLUSION
This study suggests that a programme of mentorship for primary care nurses can facilitate the decentralisation of out-patient mental health care from specialised district hospital mental health services to HCs in rural Rwanda.