Adapting chronic care models for diabetes care delivery in low-and-middle-income countries: A review

Abstract

A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes. The Philippines was used as the setting of a low-to-middle-income country. A context-based narrative review of existing models for chronic care was conducted. A situational analysis was done at the grassroots level, involving the leaders and members of the community, the patients, the local health system and the healthcare providers. A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions. The analyses indicated that care for chronic conditions may be introduced, considering the needs of people with diabetes in particular and the community in general as recipients of care, and the issues and factors that may affect the healthcare workers and the health system as providers of this care. The context-adapted chronic care model-based service delivery model was constructed accordingly. Key features are: incorporation of chronic care in the health system’s services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population, risk identification, screening, counseling including self-care development, and clinical management of the chronic condition and any co-morbidities, regardless of level of control of the condition. This way, low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.

Keywords: Chronic care models, Context adaptation, Diabetes mellitus type 2, Low-to-middle income countries, Service delivery model

Core tip: This paper introduces strategies that low-to-middle-income countries can employ to introduce feasible care and prevention for diabetes amidst problems of the double burden of disease and scarcity of resources, and presents a context-adapted service delivery model that integrates care for diabetes and similar chronic conditions in the current health services and assimilates the delivery of diabetes care with other responsibilities of the health system so that people under the care of health services and the health system can experience the whole spectrum of diabetes prevention and care.