Chronic diseases and multi-morbidity - a conceptual modification to the WHO ICCC model for countries in health transition

dc.contributor.authorOni, Tolu
dc.contributor.authorMcGrath, Nuala
dc.contributor.authorBeLue, Rhonda
dc.contributor.authorRoderick, Paul
dc.contributor.authorColagiuri, Stephen
dc.contributor.authorMay, Carl R
dc.contributor.authorLevitt, Naomi S
dc.date.accessioned2015-02-16T12:50:09Z
dc.date.available2015-02-16T12:50:09Z
dc.date.issued2014-06-09
dc.date.updated2015-01-15T17:58:31Z
dc.description.abstractBackground: The burden of non-communicable diseases is rising, particularly in low and middle-income countries undergoing rapid epidemiological transition. In sub-Saharan Africa, this is occurring against a background of infectious chronic disease epidemics, particularly HIV and tuberculosis. Consequently, multi-morbidity, the co-existence of more than one chronic condition in one person, is increasing; in particular multimorbidity due to comorbid non-communicable and infectious chronic diseases (CNCICD). Such complex multimorbidity is a major challenge to existing models of healthcare delivery and there is a need to ensure integrated care across disease pathways and across primary and secondary care. Discussion: The Innovative Care for Chronic Conditions (ICCC) Framework developed by the World Health Organization provides a health systems roadmap to meet the increasing needs of chronic disease care. This framework incorporates community, patient, healthcare and policy environment perspectives, and forms the cornerstone of South Africa’s primary health care re-engineering and strategic plan for chronic disease management integration. However, it does not significantly incorporate complexity associated with multimorbidity and CNCICD. Using South Africa as a case study for a country in transition, we identify gaps in the ICCC framework at the micro-, meso-, and macro-levels. We apply the lens of CNCICD and propose modification of the ICCC and the South African Integrated Chronic Disease Management plan. Our framework incorporates the increased complexity of treating CNCICD patients, and highlights the importance of biomedicine (biological interaction). We highlight the patient perspective using a patient experience model that proposes that treatment adherence, healthcare utilization, and health outcomes are influenced by the relationship between the workload that is delegated to patients by healthcare providers, and patients’ capacity to meet the demands of this workload. We link these issues to provider perspectives that interact with healthcare delivery and utilization. Summary: Our proposed modification to the ICCC Framework makes clear that healthcare systems must work to make sense of the complex collision between biological phenomena, clinical interpretation, beliefs and behaviours that follow from these. We emphasize the integration of these issues with the socio-economic environment to address issues of complexity, access and equity in the integrated management of chronic diseases previously considered in isolation.en_ZA
dc.identifier.apacitationOni, T., McGrath, N., BeLue, R., Roderick, P., Colagiuri, S., May, C. R., & Levitt, N. S. (2014). Chronic diseases and multi-morbidity - a conceptual modification to the WHO ICCC model for countries in health transition. <i>BMC Public Health</i>, http://hdl.handle.net/11427/12483en_ZA
dc.identifier.chicagocitationOni, Tolu, Nuala McGrath, Rhonda BeLue, Paul Roderick, Stephen Colagiuri, Carl R May, and Naomi S Levitt "Chronic diseases and multi-morbidity - a conceptual modification to the WHO ICCC model for countries in health transition." <i>BMC Public Health</i> (2014) http://hdl.handle.net/11427/12483en_ZA
dc.identifier.citationOni, Tolu; McGrath, Nuala; BeLue, Rhonda; Roderick, Paul; Colagiuri, Stephen; May, Carl R. and Levitt, Naomi S. (2014) Chronic diseases and multi-morbidity - a conceptual modification to the WHO ICCC model for countries in health transition. BMC Public Health. 14(1):575-582.en_ZA
dc.identifier.ris TY - Journal Article AU - Oni, Tolu AU - McGrath, Nuala AU - BeLue, Rhonda AU - Roderick, Paul AU - Colagiuri, Stephen AU - May, Carl R AU - Levitt, Naomi S AB - Background: The burden of non-communicable diseases is rising, particularly in low and middle-income countries undergoing rapid epidemiological transition. In sub-Saharan Africa, this is occurring against a background of infectious chronic disease epidemics, particularly HIV and tuberculosis. Consequently, multi-morbidity, the co-existence of more than one chronic condition in one person, is increasing; in particular multimorbidity due to comorbid non-communicable and infectious chronic diseases (CNCICD). Such complex multimorbidity is a major challenge to existing models of healthcare delivery and there is a need to ensure integrated care across disease pathways and across primary and secondary care. Discussion: The Innovative Care for Chronic Conditions (ICCC) Framework developed by the World Health Organization provides a health systems roadmap to meet the increasing needs of chronic disease care. This framework incorporates community, patient, healthcare and policy environment perspectives, and forms the cornerstone of South Africa’s primary health care re-engineering and strategic plan for chronic disease management integration. However, it does not significantly incorporate complexity associated with multimorbidity and CNCICD. Using South Africa as a case study for a country in transition, we identify gaps in the ICCC framework at the micro-, meso-, and macro-levels. We apply the lens of CNCICD and propose modification of the ICCC and the South African Integrated Chronic Disease Management plan. Our framework incorporates the increased complexity of treating CNCICD patients, and highlights the importance of biomedicine (biological interaction). We highlight the patient perspective using a patient experience model that proposes that treatment adherence, healthcare utilization, and health outcomes are influenced by the relationship between the workload that is delegated to patients by healthcare providers, and patients’ capacity to meet the demands of this workload. We link these issues to provider perspectives that interact with healthcare delivery and utilization. Summary: Our proposed modification to the ICCC Framework makes clear that healthcare systems must work to make sense of the complex collision between biological phenomena, clinical interpretation, beliefs and behaviours that follow from these. We emphasize the integration of these issues with the socio-economic environment to address issues of complexity, access and equity in the integrated management of chronic diseases previously considered in isolation. DA - 2014-06-09 DB - OpenUCT DO - 10.1186/1471-2458-14-575 DP - University of Cape Town J1 - BMC Public Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Chronic diseases and multi-morbidity - a conceptual modification to the WHO ICCC model for countries in health transition TI - Chronic diseases and multi-morbidity - a conceptual modification to the WHO ICCC model for countries in health transition UR - http://hdl.handle.net/11427/12483 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/12483
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2458-14-575
dc.identifier.vancouvercitationOni T, McGrath N, BeLue R, Roderick P, Colagiuri S, May CR, et al. Chronic diseases and multi-morbidity - a conceptual modification to the WHO ICCC model for countries in health transition. BMC Public Health. 2014; http://hdl.handle.net/11427/12483.en_ZA
dc.languageengen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentDivision of Endocrinology and Diabetologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0)*
dc.rights.holderOni et al.; licensee BioMed Central Ltd.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_ZA
dc.sourceBMC Public Healthen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpublichealth/
dc.subject.lcshChronic diseasesen_ZA
dc.subject.otherEpidemiological transitionen_ZA
dc.subject.otherMulti-morbidityen_ZA
dc.titleChronic diseases and multi-morbidity - a conceptual modification to the WHO ICCC model for countries in health transitionen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetype
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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