Health System Challenges in Organizing Quality Diabetes Care for Urban Poor in South India
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{"title"=>"Health system challenges in organizing quality diabetes care for urban poor in South India", "type"=>"journal", "authors"=>[{"first_name"=>"Upendra", "last_name"=>"Bhojani", "scopus_author_id"=>"35387366600"}, {"first_name"=>"Narayanan", "last_name"=>"Devedasan", "scopus_author_id"=>"56352243500"}, {"first_name"=>"Arima", "last_name"=>"Mishra", "scopus_author_id"=>"56020071100"}, {"first_name"=>"Stefaan", "last_name"=>"De Henauw", "scopus_author_id"=>"55934461100"}, {"first_name"=>"Patrick", "last_name"=>"Kolsteren", "scopus_author_id"=>"6603882639"}, {"first_name"=>"Bart", "last_name"=>"Criel", "scopus_author_id"=>"7004069104"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84906968500", "pui"=>"600018028", "doi"=>"10.1371/journal.pone.0106522", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "sgr"=>"84906968500", "pmid"=>"25188582"}, "id"=>"b50e2a7b-082c-399d-bf19-a05da66ee11c", "abstract"=>"BACKGROUND: Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2.\\n\\nMETHODS: We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis.\\n\\nRESULT: There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity.\\n\\nCONCLUSIONS: Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.", "link"=>"http://www.mendeley.com/research/health-system-challenges-organizing-quality-diabetes-care-urban-poor-south-india-2", "reader_count"=>49, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>1, "Librarian"=>1, "Researcher"=>5, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>11, "Student > Postgraduate"=>8, "Student > Master"=>9, "Other"=>1, "Student > Bachelor"=>3, "Lecturer"=>1, "Professor"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>1, "Librarian"=>1, "Researcher"=>5, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>11, "Student > Postgraduate"=>8, "Student > Master"=>9, "Other"=>1, "Student > Bachelor"=>3, "Lecturer"=>1, "Professor"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>4, "Nursing and Health Professions"=>3, "Agricultural and Biological Sciences"=>2, "Medicine and Dentistry"=>17, "Arts and Humanities"=>3, "Business, Management and Accounting"=>5, "Sports and Recreations"=>1, "Social Sciences"=>9, "Computer Science"=>4, "Economics, Econometrics and Finance"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>17}, "Social Sciences"=>{"Social Sciences"=>9}, "Sports and Recreations"=>{"Sports and Recreations"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>2}, "Computer Science"=>{"Computer Science"=>4}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>5}, "Unspecified"=>{"Unspecified"=>4}, "Arts and Humanities"=>{"Arts and Humanities"=>3}}, "reader_count_by_country"=>{"United States"=>2, "South Africa"=>1, "Nigeria"=>1, "India"=>4}, "group_count"=>4}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1662493"], "description"=>"<p>Dominant themes pertaining to local health system challenges in KG Halli.</p>", "links"=>[], "tags"=>["KG Halli", "health systems", "health system", "South India BackgroundWeak health systems", "Organizing Quality Diabetes Care", "healthcare delivery platforms", "health system dynamics framework", "diabetes mellitus type 2. MethodsWe", "quality diabetes care", "health System Challenges", "healthcare providers"], "article_id"=>1161989, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Upendra Bhojani", "Narayanan Devedasan", "Arima Mishra", "Stefaan De Henauw", "Patrick Kolsteren", "Bart Criel"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0106522.t002", "stats"=>{"downloads"=>2, "page_views"=>26, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Dominant_themes_pertaining_to_local_health_system_challenges_in_KG_Halli_/1161989", "title"=>"Dominant themes pertaining to local health system challenges in KG Halli.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-09-04 04:10:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/1662491"], "description"=>"<p>The health systems dynamics framework developed by Van Olmen et al <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0106522#pone.0106522-VanOlmen1\" target=\"_blank\">[18]</a> at the Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.</p>", "links"=>[], "tags"=>["KG Halli", "health systems", "health system", "South India BackgroundWeak health systems", "Organizing Quality Diabetes Care", "healthcare delivery platforms", "health system dynamics framework", "diabetes mellitus type 2. MethodsWe", "quality diabetes care", "health System Challenges", "healthcare providers"], "article_id"=>1161987, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Upendra Bhojani", "Narayanan Devedasan", "Arima Mishra", "Stefaan De Henauw", "Patrick Kolsteren", "Bart Criel"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0106522.g001", "stats"=>{"downloads"=>10, "page_views"=>161, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Health_systems_dynamics_framework_/1161987", "title"=>"Health systems dynamics framework.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-09-04 04:10:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/1662492"], "description"=>"<p>Profile of respondents.</p>", "links"=>[], "tags"=>["KG Halli", "health systems", "health system", "South India BackgroundWeak health systems", "Organizing Quality Diabetes Care", "healthcare delivery platforms", "health system dynamics framework", "diabetes mellitus type 2. MethodsWe", "quality diabetes care", "health System Challenges", "healthcare providers"], "article_id"=>1161988, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Upendra Bhojani", "Narayanan Devedasan", "Arima Mishra", "Stefaan De Henauw", "Patrick Kolsteren", "Bart Criel"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0106522.t001", "stats"=>{"downloads"=>1, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Profile_of_respondents_/1161988", "title"=>"Profile of respondents.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-09-04 04:10:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/1662495"], "description"=>"<div><p>Background</p><p>Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2.</p><p>Methods</p><p>We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis.</p><p>Result</p><p>There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients’ medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity.</p><p>Conclusions</p><p>Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.</p></div>", "links"=>[], "tags"=>["KG Halli", "health systems", "health system", "South India BackgroundWeak health systems", "Organizing Quality Diabetes Care", "healthcare delivery platforms", "health system dynamics framework", "diabetes mellitus type 2. MethodsWe", "quality diabetes care", "health System Challenges", "healthcare providers"], "article_id"=>1161991, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Upendra Bhojani", "Narayanan Devedasan", "Arima Mishra", "Stefaan De Henauw", "Patrick Kolsteren", "Bart Criel"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0106522", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Health_System_Challenges_in_Organizing_Quality_Diabetes_Care_for_Urban_Poor_in_South_India_/1161991", "title"=>"Health System Challenges in Organizing Quality Diabetes Care for Urban Poor in South India", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-09-04 04:10:28"}

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Relative Metric

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