DataSheet4_Factors Influencing the Implementation of Remote Delivery Strategies for Non-Communicable Disease Care in Low- and Middle-Income Countries: A Narrative Review.pdf

Objectives: The COVID-19 pandemic has disrupted health care for non-communicable diseases (NCDs) and necessitated strategies to minimize contact with facilities. We aimed to examine factors influencing implementation of remote (non-facility-based) delivery approaches for people with hypertension and/or diabetes in low- and middle-income countries (LMICs), to inform NCD care delivery during health service disruption, including humanitarian crises.
Methods: Our narrative review used a hermeneutic and purposive approach, including primary studies conducted in LMICs, which assessed implementation factors influencing remote NCD care delivery. Results were analyzed using the Consolidated Framework for Implementation Research.
Results: Twenty-eight included studies revealed the strong influence of both internal organizational and broader contextual factors, such as community health worker policies or technological environment. Addressing patients’ specific characteristics, needs and resources was important for implementation success.
Conclusion: This review highlighted the multiple, complex, interdependent factors influencing implementation of remote NCD care in LMICs. Our findings may inform actors designing NCD care delivery in contexts where facility-based access is challenging. Implementation research is needed to evaluate context-adapted e-Health, community-based, and simplified clinical management strategies to facilitate remote NCD care.

研究目的：新冠疫情对非传染性疾病（non-communicable diseases, NCDs）的医疗服务造成严重冲击，亟需制定策略以降低患者与医疗机构的接触风险。本研究旨在探讨低收入和中等收入国家（low- and middle-income countries, LMICs）中，影响高血压和/或糖尿病患者远程（非医疗机构依托型）服务模式实施的相关因素，为卫生服务中断（包括人道主义危机）期间的非传染性疾病医疗服务提供决策参考。
研究方法：本叙事性综述（narrative review）采用诠释学与目的性研究思路，纳入了在低收入和中等收入国家开展的、评估远程非传染性疾病医疗服务实施影响因素的原始研究，并运用综合实施研究框架（Consolidated Framework for Implementation Research）对研究结果进行分析。
研究结果：纳入的28项研究显示，内部组织因素与更广泛的背景因素均对服务实施具有显著影响，例如社区卫生工作者政策或技术环境。充分考量患者的具体特征、需求与资源，是保障服务顺利实施的关键。
研究结论：本综述明确了在低收入和中等收入国家中，影响远程非传染性疾病医疗服务实施的多重、复杂且相互关联的因素。本研究结果可为医疗机构可及性欠佳场景下设计非传染性疾病医疗服务方案的相关主体提供参考。未来需开展实施研究，以评估适配场景的电子健康（e-Health）、基于社区以及简化临床管理策略，从而推动远程非传染性疾病医疗服务的落地实施。