title: Redesigning primary care to tackle the global epidemic of noncommunicable disease.
abstract: Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countries, historically oriented to infectious disease and often severely underfunded, are poorly prepared for the challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resource-constrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication.
authors.affiliation: At the time of the study, Margaret E. Kruk was with the Department of Health Policy and Management and Better Health Systems Initiative, Mailman School of Public Health, Columbia University, New York, NY. At the time of the study, Gustavo Nigenda was with the Harvard Global Equity Initiative, Harvard University, Boston, MA. Felicia Marie Knaul is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston, and the Harvard Global Equity Initiative, Boston.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
authors.forename: Gustavo
authors.initials: G
authors.lastname: Nigenda
authors.forename: Felicia M
authors.initials: FM
authors.lastname: Knaul
mesh_terms: D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D003150:Community Health Workers / Q000191:economics / Q000592:standards / Q000639:trends; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards* / Q000639:trends; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data; D005194:Family Practice / Q000191:economics / Q000592:standards / Q000639:trends; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods; D059408:Pain Management / Q000379:methods / Q000592:standards; D010348:Patient Care Team / Q000191:economics / Q000592:standards* / Q000639:trends; D011320:Primary Health Care / Q000191:economics / Q000592:standards* / Q000639:trends; D011788:Quality of Life; D012307:Risk Factors; D017216:Telemedicine / Q000191:economics / Q000592:standards / Q000639:trends