The efficiency of chronic disease care in sub-Saharan Africa

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Abstract

The number of people needing chronic disease care is projected to increase in sub-Saharan Africa as a result of expanding human immunodeficiency virus (HIV) treatment coverage, rising life expectancies, and lifestyle changes. Using nationally representative data of healthcare facilities, Di Giorgio et al. found that many HIV clinics in Kenya, Uganda, and Zambia appear to have considerable untapped capacity to provide care for additional patients. These findings highlight the potential for increasing the efficiency of clinical processes for chronic disease care at the facility level. Important questions for future research are how estimates of comparative technical efficiency across facilities change, when they are adjusted for quality of care and the composition of patients by care complexity. Looking ahead, substantial research investment will be needed to ensure that we do not forgo the opportunity to learn how efficiency changes, as chronic care is becoming increasingly differentiated by patient type and integrated across diseases and health systems functions.

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Most cited references 11

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Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV infection- Recommendations for a Public Health Approach

WHO WHO (2013)

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Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine.

L Melissa Skaugset, Susan Farrell, Michele Carney … (2016)

Emergency physicians work in a fast-paced environment that is characterized by frequent interruptions and the expectation that they will perform multiple tasks efficiently and without error while maintaining oversight of the entire emergency department. However, there is a lack of definition and understanding of the behaviors that constitute effective task switching and multitasking, as well as how to improve these skills. This article reviews the literature on task switching and multitasking in a variety of disciplines-including cognitive science, human factors engineering, business, and medicine-to define and describe the successful performance of task switching and multitasking in emergency medicine. Multitasking, defined as the performance of two tasks simultaneously, is not possible except when behaviors become completely automatic; instead, physicians rapidly switch between small tasks. This task switching causes disruption in the primary task and may contribute to error. A framework is described to enhance the understanding and practice of these behaviors.

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Is Open Access

Pathophysiology and Management of Cardiovascular Disease in HIV-Infected Patients

Eric Nou, Janet Lo, Colleen Hadigan … (2016)

Summary A number of studies suggest that HIV-infected individuals have an elevated risk of cardiovascular disease (CVD), especially coronary heart disease, compared to the HIV-uninfected population. People living with HIV have an increased prevalence of traditional CVD risk factors but HIV-specific mechanisms such as immune activation and antiretroviral therapy also play critical roles. Although older, more metabolically harmful antiretroviral regimens likely contributed to the risk of cardiovascular disease, emerging data suggest that the overall effect of early and continuous use of modern regimens, which may have fewer metabolic consequences, minimizes the risk of myocardial infarction by maintaining viral suppression and decreasing immune activation. Even with antiretroviral therapy, however, immune activation persists in HIV-infected individuals and may contribute to accelerated atherosclerosis, especially of vulnerable coronary lesions that predispose to myocardial infarction. Thus, therapies that safely reduce inflammation in the HIV population may provide additional cardiovascular protection alongside treatment of both traditional and other, non-traditional risk factors.

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Author and article information

Contributors

Pascal Geldsetzer: pgeldset@hsph.harvard.edu

Katrina Ortblad: katrina.ortblad@mail.harvard.edu

Till Bärnighausen: tbaernig@hsph.harvard.edu

Journal

Journal ID (nlm-ta): BMC Med

Journal ID (iso-abbrev): BMC Med

Title: BMC Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1741-7015

Publication date (Electronic): 26 August 2016

Publication date PMC-release: 26 August 2016

Publication date Collection: 2016

Volume: 14

Issue: 1

Electronic Location Identifier: 127

Affiliations

[1 ]Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA 02115 USA

[2 ]Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, Heidelberg, 69120 Germany

[3 ]Africa Health Research Institute, P.O. Box 198, Mtubatuba, 3935 South Africa

Article

Publisher ID: 675

DOI: 10.1186/s12916-016-0675-6

PMC ID: 5002156

PubMed ID: 27566531

SO-VID: 302194be-4320-4091-b54a-f447e5c3505f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 2 August 2016

Date accepted : 19 August 2016

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ScienceOpen disciplines: Medicine

Keywords: efficiency,differentiated care,integrated care,chronic diseases,antiretroviral therapy,hiv,non-communicable diseases

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ScienceOpen disciplines: Medicine

Keywords: efficiency, differentiated care, integrated care, chronic diseases, antiretroviral therapy, hiv, non-communicable diseases

The efficiency of chronic disease care in sub-Saharan Africa

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Annual Reviews HIV/AIDS: Public Health and Society

Most cited references 11

Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV infection- Recommendations for a Public Health Approach

Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine.

Pathophysiology and Management of Cardiovascular Disease in HIV-Infected Patients

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