scholarly journals Primary care financing: a systematic assessment of research priorities in low- and middle-income countries

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001483 ◽  
Author(s):  
Felicity Goodyear-Smith ◽  
Andrew Bazemore ◽  
Megan Coffman ◽  
Richard Fortier ◽  
Amanda Howe ◽  
...  
Keyword(s):  
Primary Care ◽  
Research Priorities ◽  
Knowledge Gaps ◽  
Middle Income ◽  
Policy Makers ◽  
Diverse Range ◽  
Middle Income Countries ◽  
Delphi Round ◽  
Research Questions ◽  
Low And Middle Income

IntroductionFinancing of primary healthcare (PHC) is the key to the provision of equitable universal care. We aimed to identify and prioritise the perceived needs of PHC practitioners and researchers for new research in low- and middle-income countries (LMIC) about financing of PHC.MethodsThree-round expert panel consultation using web-based surveys of LMIC PHC practitioners, academics and policy-makers sampled from global networks. Iterative literature review conducted in parallel. First round (Pre-Delphi survey) elicited possible research questions to address knowledge gaps about financing. Responses were independently coded, collapsed and synthesised to two lists of questions. Round 2 (Delphi Round 1) invited panellists to rate importance of each question. In Round 3 (Delphi Round 2), panellists ranked questions in order of importance.ResultsA diverse range of PHC practitioners, academics and policy-makers in LMIC representing all global regions identified 479 knowledge gaps as potentially critical to improving PHC financing. Round 2 provided 31 synthesised questions on financing for rating. The top 16 were ranked in Round 3e to produce four prioritised research questions.ConclusionsThis novel exercise created an expansive and prioritised list of critical knowledge gaps in PHC financing research questions. This offers valuable guidance to global supporters of primary care evaluation and implementation, including research funders and academics seeking research priorities. The source and context specificity of this research, informed by LMIC practitioners and academics on a global and local basis, should increase the likelihood of local relevance and eventual success in implementing the findings.

scholarly journals A patient–clinician James Lind Alliance partnership to identify research priorities for hyperemesis gravidarum

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041254
Author(s):  
Caitlin R Dean ◽  
Hyke Bierma ◽  
Ria Clarke ◽  
Brian Cleary ◽  
Patricia Ellis ◽  
...  
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Hyperemesis Gravidarum ◽  
Research Priorities ◽  
Developed Countries ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
James Lind Alliance ◽  
Research Questions

ObjectiveThere are many uncertainties surrounding the aetiology, treatment and sequelae of hyperemesis gravidarum (HG). Prioritising research questions could reduce research waste, helping researchers and funders direct attention to those questions which most urgently need addressing. The HG priority setting partnership (PSP) was established to identify and rank the top 25 priority research questions important to both patients and clinicians.MethodsFollowing the James Lind Alliance (JLA) methodology, an HG PSP steering group was established. Stakeholders representing patients, carers and multidisciplinary professionals completed an online survey to gather uncertainties. Eligible uncertainties related to HG. Uncertainties on nausea and vomiting of pregnancy and those on complementary treatments were not eligible. Questions were verified against the evidence. Two rounds of prioritisation included an online ranking survey and a 1-hour consensus workshop.Results1009 participants (938 patients/carers, 118 professionals with overlap between categories) submitted 2899 questions. Questions originated from participants in 26 different countries, and people from 32 countries took part in the first prioritisation stage. 66 unique questions emerged, which were evidence checked according to the agreed protocol. 65 true uncertainties were narrowed via an online ranking survey to 26 unranked uncertainties. The consensus workshop was attended by 19 international patients and clinicians who reached consensus on the top 10 questions for international researchers to address. More patients than professionals took part in the surveys but were equally distributed during the consensus workshop. Participants from low-income and middle-income countries noted that the priorities may be different in their settings.ConclusionsBy following the JLA method, a prioritised list of uncertainties relevant to both HG patients and their clinicians has been identified which can inform the international HG research agenda, funders and policy-makers. While it is possible to conduct an international PSP, results from developed countries may not be as relevant in low-income and middle-income countries.

scholarly journals Primary Care Research Priorities in Low-and Middle-Income Countries

2019 ◽  
Vol 17 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Felicity Goodyear-Smith ◽  
Andrew Bazemore ◽  
Megan Coffman ◽  
Richard Fortier ◽  
Amanda Howe ◽  
...  
Keyword(s):  
Primary Care ◽  
Research Priorities ◽  
Middle Income ◽  
Primary Care Research ◽  
Care Research ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001482 ◽  
Author(s):  
Felicity Goodyear-Smith ◽  
Andrew Bazemore ◽  
Megan Coffman ◽  
Richard D W Fortier ◽  
Amanda Howe ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Low Income ◽  
Primary Healthcare ◽  
Models Of Care ◽  
Global Networks ◽  
Middle Income ◽  
Diverse Range ◽  
Middle Income Countries ◽  
Delphi Round ◽  
Research Questions

IntroductionSince the Alma-Ata Declaration 40 years ago, primary healthcare (PHC) has made great advances, but there is insufficient research on models of care and outcomes—particularly for low-income and middle-income countries (LMICs). Systematic efforts to identify these gaps and develop evidence-based strategies for improvement in LMICs has been lacking. We report on a global effort to identify and prioritise the knowledge needs of PHC practitioners and researchers in LMICs about PHC organisation.MethodsThree-round modified Delphi using web-based surveys. PHC practitioners and academics and policy-makers from LMICs sampled from global networks. First round (pre-Delphi survey) collated possible research questions to address knowledge gaps about organisation. Responses were independently coded, collapsed and synthesised. Round 2 (Delphi round 1) invited panellists to rate importance of each question. In round 3 (Delphi round 2), panellists ranked questions into final order of importance. Literature review conducted on 36 questions and gap map generated.ResultsDiverse range of practitioners and academics in LMICs from all global regions generated 744 questions for PHC organisation. In round 2, 36 synthesised questions on organisation were rated. In round 3, the top 16 questions were ranked to yield four prioritised questions in each area. Literature reviews confirmed gap in evidence on prioritised questions in LMICs.ConclusionIn line with the 2018 Astana Declaration, this mixed-methods study has produced a unique list of essential gaps in our knowledge of how best to organise PHC, priority-ordered by LMIC expert informants capable of shaping their mitigation. Research teams in LMIC have developed implementation plans to answer the top four ranked research questions.

The role of primary care in low- and middle-income countries

2013 ◽  
pp. 96-113 ◽  
Author(s):  
David Goldberg ◽  
Graham Thornicroft ◽  
Nadja van Ginneken
Keyword(s):  
Primary Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Models of community-based primary care for epilepsy in low- and middle-income countries

Neurology ◽  
2020 ◽  
Vol 94 (4) ◽  
pp. 165-175 ◽  
Author(s):  
Gagandeep Singh ◽  
Meenakshi Sharma ◽  
Anand Krishnan ◽  
Tarun Dua ◽  
Francesco d'Aniello ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Treatment Adherence ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Community Awareness ◽  
Primary Health ◽  
Low And Middle Income

ObjectiveTo review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries.MethodsA systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles.ResultsThe 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans.ConclusionsCost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.

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