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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1392-1394
Ensuring delivery of integrated care for reducing the morbidity and mortality attributed to cardiovascular diseases


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu, India

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Date of Web Publication6-Nov-2017
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Ensuring delivery of integrated care for reducing the morbidity and mortality attributed to cardiovascular diseases. Ann Trop Med Public Health 2017;10:1392-4

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Ensuring delivery of integrated care for reducing the morbidity and mortality attributed to cardiovascular diseases. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Dec 15];10:1392-4. Available from: http://www.atmph.org/text.asp?2017/10/5/1392/196754


Dear Editor,

Globally, cardiovascular diseases (CVDs) have been ranked as the leading cause of mortality, accounting for more than 30% of total deaths reported worldwide.[1] Further, more than 75% of all CVD associated deaths have been reported in low-and middle-income nations.[1] However, it is quite important to realize that even though developed nations have a small share in terms of total number of CVD attributed deaths, yet they contribute a large number of cases of CVDs to the global prevalence pool.[1] Infact, these diseases continue to remain as one of the leading causes of morbidity and mortality in the United States or even European nations, predominantly because of the high prevalence of all predisposing factors in the population.[2],[3]

The trends from Lithuania also presented a similar sort of epidemiological picture with high CVD incidence and associated mortality rates among both women and men population, and a high prevalence of most of the lifestyle and other modifiable risk factors responsible for the causation of the disease.[4] The problem was further complicated by the poor organization and delivery of services, with cardiology institutes being overstaffed while regional hospitals faced the challenge of a shortage of human resources, especially in rural settings.[4]

Thus, most of the people preferred availing care directly in specialty clinics by passing the primary health care, and hence there was poor coordination between doctors, tests were repeated unnecessarily, and even patients had to wait for a long time for their consultation in tertiary hospitals.[4]

To transform the pattern of delivery of the services in the nation, the stakeholders from different institutes got united to respond to the hospital-centric delivery of care and the disparity prevalent in the urban and rural settings in the health sector.[4],[5] A range of interventions, such as giving extra impedance on the importance of primary care, improving coordination between hospital outpatient consultations and admissions, strengthening the referral system to keep a better track of patients, and providing training to the doctors from the regional hospitals/local clinics to improve their skills, were implemented to deal with the existing challenges.[3],[4],[5] In addition, the patients were empowered to deal with their disease and even given access to their health records, and an assurance was given for the availability of health providers, whenever they were in need.[4] The results of these interventions were quite encouraging, as a significant increase in the availability of health professionals and an increase in outpatient consultation, especially in secondary-level health establishments; reduction in mortality rates or prevalence of risk factors; and even better access to medications were observed.[4]

However, the real reason for the improvement was due to the integration of all cardiovascular services (viz. prevention, diagnosis, and treatment), right from the grass-root level to even the tertiary level of health care facilities.[4],[5] Infact, the World Health Organization and other member states have adopted a framework on integrated people-centered health services.[5] Finally, it is important to realize at policy makers level that if nations have to progress on their health dimension, people should be empowered to take charge of their own health, and the health system has to be strengthened from all aspects.[1],[4],[5][6]

To conclude, in the global mission to improve the health standards of people and ensure universal health coverage, it is extremely essential to address the needs of the people instead of specific diseases, and every effort should be taken to improve the coordination of care among all the stakeholders.

Acknowledgment

SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

JR contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Cardiovascular diseases (CVDs)-Fact sheet; 2016. Available from: http://www.who.int/mediacentre/factsheets/fs317/en/. [Last accessed on 2016 July 5].  Back to cited text no. 1
    
2.
Shrivastava SR, Shrivastava PS, Ramasamy J, Coronary heart disease: pandemic in a true sense. J Cardiovasc Thorac Res 2013;5:125-6.  Back to cited text no. 2
    
3.
Tamosiunas A, Luksiene D, Baceviciene M, Bernotiene G, Radisauskas R, Malinauskiene V, et al. Health factors and risk of all-cause, cardiovascular, and coronary heart disease mortality: findings from the MONICA and HAPIEE studies in Lithuania. PLoS One 2014;9:e114283.  Back to cited text no. 3
[PUBMED]    
4.
World Health OrganizationRight care, right time, right place: how Lithuania transformed cardiology care; 2016. Available from: http://who.int/features/2016/lithuania-transforms-care/en/. [Last accessed on 2016 July 8].  Back to cited text no. 4
    
5.
World Health OrganizationWHO Framework on integrated people-centred health services; 2016. Available from: http://who.int/servicedeliverysafety/areas/people-centred-care/en/. [Last accessedccessed on 2016 July 8].  Back to cited text no. 5
    
6.
Maina JM, Kithuka P, Tororei S. Perceptions and uptake of health insurance for maternal care in rural Kenya: a cross sectional study. Pan Afr Med J 2016;23:125.  Back to cited text no. 6
[PUBMED]    

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Correspondence Address:
Saurabh R Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196754

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