Community-integrated noncommunicable disease service models: lessons from China

Area of Science:

• Public Health
• Health Services Research
• Non-communicable Diseases

Background:

• Integrated health services are crucial for primary healthcare in low- and middle-income countries (LMICs) to manage non-communicable diseases (NCDs).
• Limited evidence exists on effective NCD care delivery models and scalability in LMICs.
• China's health system reorientation towards primary care for NCDs provides a relevant case study.

Purpose of the Study:

• To examine community-integrated NCD service models in China.
• To provide evidence on China's strategies for reorienting health services to primary care for NCDs.
• To offer insights for other LMICs facing NCD epidemics.

Main Methods:

• A systematic review of 20 studies from five databases (English and Chinese).
• Narrative and thematic evidence synthesis based on the Chronic Care Model and WHO PEN interventions.
• Analysis of priority diseases, interventions, delivery strategies, stakeholder roles, challenges, outcomes, and gaps.

Main Results:

• Various community-level integrated NCD service models have been trialled and scaled up in China despite resource limitations.
• Key interventions include health promotion, screening, tiered care, patient education, self-management, and digital health.
• Family physicians and nurses, supported by local governments and hospitals, are key providers, leading to improved patient pathways and outcomes.

Conclusions:

• China's community-integrated NCD models offer valuable lessons for LMICs, emphasizing universal health coverage and integrated public health/primary care.
• Optimizing accessibility, efficiency, and patient-centeredness are key elements for success.
• Future research should explore long-term effects and sustainability, especially in rural areas.