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      Access to hypertension care and services in primary health-care settings in Vietnam: a systematic narrative review of existing literature

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          ABSTRACT

          Background: Health care in Vietnam is challenged by a high burden of hypertension (HTN). Since 2000, several interventions were implemented to manage HTN; it is not clear what is the status of patient access to HTN care.

          Objective: This article aims to perform a systematic narrative review of the available evidence on access to HTN care and services in primary health-care settings in Vietnam.

          Methods: Search engines were used to identify relevant records of scientific and grey literature. Data from selected articles were analysed using standardised spreadsheets and MaxQDA and following a framework synthesis methodology.

          Results: There has been increasing interest in research and policy concerning the burden of HTN in Vietnam, covering many aspects of access to treatment at the primary health-care level. Vietnam’s National HTN Programme is managed as a vertical programme and its services integrated into the network of primary health-care facilities across the public sector in selected provinces. The Programme financed population-wide screening campaigns for the early detection of HTN among people above 40 years of age. There was no information on the acceptability of HTN health services, especially regarding the interaction between patients and health professionals. In general, articles reported good availability of medication, but problems in accessing them included: fragmentation and lack of consistency in prescribing medication between different levels and short timespans for dispensing medication at primary health-care facilities. There was limited information related to the cost and economic impact of HTN treatment. Treatment adherence among hypertensive patients based on four studies did not exceed 70%.

          Conclusions: Although the Vietnamese health-care system has taken steps to accommodate some of the needs of HTN patients, it is crucial to scale-up interventions that allow for regular, systematic, and integrated care, especially at the lowest levels of care.

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          Most cited references38

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          Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries.

          The burden of chronic, non-communicable diseases in low-income and middle-income countries is increasing. We outline a framework for monitoring of such diseases and review the mortality burden and the capacity of countries to respond to them. We show data from WHO data sources and published work for prevalence of tobacco use, overweight, and cause-specific mortality in 23 low-income and middle-income countries with a high burden of non-communicable disease. Data for national capacity for chronic disease prevention and control were generated from a global assessment that was done in WHO member states in 2009-10. Although reliable data for cause-specific mortality are scarce, non-communicable diseases were estimated to be responsible for 23·4 million (or 64% of the total) deaths in the 23 countries that we analysed, with 47% occurring in people who were younger than 70 years. Tobacco use and overweight are common in most of the countries and populations we examined, but coverage of cost-effective interventions to reduce these risk factors is low. Capacity for prevention and control of non-communicable diseases, including monitoring and surveillance operations nationally, is inadequate. A surveillance framework, including a minimum set of indicators covering exposures and outcomes, is essential for policy development and assessment and for monitoring of trends in disease. Technical, human, and fiscal resource constraints are major impediments to the establishment of effective prevention and control programmes. Despite increasing awareness and commitment to address chronic disease, concrete actions by global partners to plan and implement cost-effective interventions are inadequate. Copyright © 2010 Elsevier Ltd. All rights reserved.
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            Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries

            Background Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. Methods Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. Results We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. Conclusions Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.
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              Quality control in systematic reviews and meta-analyses.

              Systematic reviews and meta-analyses are being submitted to, and being published by biomedical journals with increasing frequency. In order to maintain the utility of such publications and avoid misguidance it is important that these studies are conducted to a high standard. This article aims to provide guidance both for those researchers undertaking and reporting such studies and for the readers of such articles. Details of a suggested method for conducting a systematic review are given, including methods for literature searches, data abstraction and data extraction followed by a brief overview of common methods used for meta-analyses and the interpretation of the results of meta-analysis.
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                Author and article information

                Journal
                Glob Health Action
                Glob Health Action
                ZGHA
                zgha20
                Global Health Action
                Taylor & Francis
                1654-9716
                1654-9880
                2019
                23 May 2019
                : 12
                : 1
                : 1610253
                Affiliations
                [a ]Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
                [b ]Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium
                [c ]Department of Social Medicine, Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy , Thai Nguyen, Vietnam
                [d ]Guelph International Health Consulting , Amsterdam, The Netherlands
                Author notes
                CONTACT Lana Meiqari Lana.Meiqari@ 123456vu.nl Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Science, Vrije Universiteit Amsterdam , De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
                Author information
                http://orcid.org/0000-0001-9348-4830
                Article
                1610253
                10.1080/16549716.2019.1610253
                6534204
                31120345
                84304faa-15d5-4dc6-a9ba-178f0a234605
                © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 August 2018
                : 15 April 2019
                Page count
                Figures: 5, Tables: 4, References: 93, Pages: 22
                Funding
                Funded by: Erasmus Mundus Joint Doctorate Fellowship
                Award ID: Specific Grant Agreement 2014–0681
                The Erasmus Mundus Joint Doctorate Fellowship [Specific Grant Agreement 2014–0681], of which LM is a beneficiary, supported this review. The funding agency had no role in study design, analysis, or preparation of the manuscript.
                Categories
                Review Article

                Health & Social care
                delivery of health care,hypertension,primary health-care settings,vietnam,access to care

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