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. 2019 Sep 11;4(5):e001806.
doi: 10.1136/bmjgh-2019-001806. eCollection 2019.

Integrated prevention and management of non-communicable diseases, including musculoskeletal health: a systematic policy analysis among OECD countries

Andrew M Briggs  1 , Jennifer G Persaud  2   3 , Marie L Deverell  3 , Samantha Bunzli  4 , Brigitte Tampin  5   6 , Yuka Sumi  7   8 , Olav Amundsen  9 , Elizabeth Mg Houlding  10 , Anontella Cardone  11   12 , Thora Hugosdottir  13 , Sophia Rogers  14 , Miklós Pozsgai  15   16 , Helen Slater  1
Affiliations

Integrated prevention and management of non-communicable diseases, including musculoskeletal health: a systematic policy analysis among OECD countries

Andrew M Briggs et al. BMJ Glob Health. .

Abstract

Introduction: Development and implementation of appropriate health policy is essential to address the rising global burden of non-communicable diseases (NCDs). The aim of this study was to evaluate existing health policies for integrated prevention/management of NCDs among Member States of the Organisation for Economic Co-operation and Development (OECD). We sought to describe policies' aims and strategies to achieve those aims, and evaluate extent of integration of musculoskeletal conditions as a leading cause of global morbidity.

Methods: Policies submitted by OECD Member States in response to a World Health Organization (WHO) NCD Capacity Survey were extracted from the WHO document clearing-house and analysed following a standard protocol. Policies were eligible for inclusion when they described an integrated approach to prevention/management of NCDs. Internal validity was evaluated using a standard instrument (sum score: 0-14; higher scores indicate better quality). Quantitative data were expressed as frequencies, while text data were content-analysed and meta-synthesised using standardised methods.

Results: After removal of duplicates and screening, 44 policies from 30 OECD Member States were included. Three key themes emerged to describe the general aims of included policies: system strengthening approaches; improved service delivery; and better population health. Whereas the policies of most countries covered cancer (83.3%), cardiovascular disease (76.6%), diabetes/endocrine disorders (76.6%), respiratory conditions (63.3%) and mental health conditions (63.3%), only half the countries included musculoskeletal health and pain (50.0%) as explicit foci. General strategies were outlined in 42 (95.5%) policies-all were relevant to musculoskeletal health in 12 policies, some relevant in 27 policies and none relevant in three policies. Three key themes described the strategies: general principles for people-centred NCD prevention/management; enhanced service delivery; and system strengthening approaches. Internal validity sum scores ranged from 0 to 13; mean: 7.6 (95% CI 6.5 to 8.7).

Conclusion: Relative to other NCDs, musculoskeletal health did not feature as prominently, although many general prevention/management strategies were relevant to musculoskeletal health improvement.

Keywords: global; health system; integrated care; musculoskeletal; non-communicable; policy.

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Conflict of interest statement

Competing interests: AMB reports grants from Department of Health, Government of Western Australia, grants from the Australian National Health and Medical Research Council, during the conduct of the study; personal fees from Department of Health, Government of Western Australia, personal fees from WHO, outside the submitted work; SB reports personal fees from Curtin University, during the conduct of the study. EMGH reports personal fees from Curtin University, grants from Mitacs Globalink Research Award, during the conduct of the study. SR reports personal fees from Curtin University, during the conduct of the study. HS reports grants from the Department of Health, Government of Western Australia during the conduct of the study.

Figures

Figure 1
Figure 1
Frequency map of diseases/health conditions (left panel) and health states (right panel) explicitly cited as within the scope or coverage of the included policies by nation. Musculoskeletal conditions encompass any condition of the musculoskeletal system or persistent non-cancer pain. Neurological conditions include any neurological or neurodegenerative condition.
Figure 2
Figure 2
Schematic of the themes and subthemes describing the strategies outlined in the included policies for integrated management of non-communicable diseases (NCDs). The themes align with the WHO Framework on Integrated People-Centred Health Services (IPCHS).. Theme 1 aligns with IPCHS strategy 1 (‘engaging and empowering people and communities’); theme 2 aligns with IPCHS strategies 3 and 4 (‘reorienting the model of care’ and ‘coordinating services within and across sectors’, respectively); theme 3 aligns with IPCHS strategy 5 (‘creating an enabling environment’).
See this image and copyright information in PMC

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