Models of care for noncommunicable diseases in primary care: key elements and design in low- and middle-income countries - a scoping review.

Abstract

Noncommunicable diseases (NCDs) pose a global health challenge, with primary health care's (PHC) potential to address them underutilized. While efforts to design and implement effective NCDs care models in low- and middle-income countries (LMICs) are increasing, conclusive recommendations are lacking. This scoping review maps literature on NCDs care models in LMICs, examining elements, theoretical foundations, and outcomes to inform the development of context-specific models. Following Arksey and O'Malley's framework, we searched PubMed, Embase, and Web of Science for articles on NCD care models in LMIC primary care. Two authors independently screened and extracted data using a 40-element framework. Identified models were categorized as implemented or theoretically proposed, analyzed by subcategory, and elements identified and compared. The search and snowballing yielded 1,011 articles. 54 met inclusion criteria, covering 44 models (25 implemented, 19 proposed). Implemented models' design was largely informed by service delivery gaps analyses. The most frequently included elements in them were education and training of the health workforce, combined self-management and patient education, guidelines/protocol-based approach, information systems, screening, team-based care, combined nurse-led and task shifting/sharing, essential medicines, essential diagnostics, community-level care, standardized referral pathways, and mentoring and supervision. Comparison of frequently included elements in implemented and proposed models showed strong alignment between them and with the recommended interventions in WHO-NCDs technical packages for primary care. This underscores these elements' relevance in addressing NCD service delivery challenges in LMICs and guiding the reorientation of PHC models to better integrate NCD services. However, further evidence is needed to support implementation.