Managing and not just preventing noncommunicable diseases in primary care: Crossroads: December 2017

Abstract

Noncommunicable diseases have claimed a front and-centre priority for all countries in the WHO European Region. The strain noncommunicable diseases pose on health systems and the quality of life of our populations has reached a critical point in term of increasing demands for public health interventions and individual health and social services in relation to budget constraints; an intensive intersectoral response and new modalities of integrated and team-oriented work are needed that guarantee the overall sustainability of health systems.In many countries, the health systems have responded to these challenges by strengthening primary care, improving coordination between providers, avoiding unnecessary and expensive hospitalization, equipping patients with tools for awareness of self-care and intensifying population based and individual public health interventions for protecting and promoting health and preventing disease. These efforts, despite being in the right direction, remain insufficient and sometimes inadequate. Getting primary care to provide responsive and high-quality services and gain the trust of the population as the first point of care and to contribute to the overall sustainability of health systems requires first-line health practitioners to not only diagnose but to also to treat and follow up common chronic diseases and conditions. From a services delivery perspective,too many efforts focus only on prevention, disregarding the needs of patients for prompt and effective diagnosis and treatment in primary care. A balance must be found in primary care between health promotion and disease prevention and the diagnosis, treatment and management of noncommunicable diseases.A primary-care strategy for preventing and managing noncommunicable diseases and conditions needs to embrace three key elements: (‎1)‎ identifying and addressing modifiable risk factors; (‎2)‎ screening for common noncommunicable diseases; and (‎3)‎ diagnosis,treatment, follow-up and coordinating patient referrals.Such a strategy should provide a structured, integrated programmatic approach to existing health and social services and has the potential to deliver high-quality primary care for people with noncommunicable diseases.Experience and research is desperately needed to improve the package of diagnostic and therapeutic tools required for primary care and to adapt models of delivery that are integrated and people-centred. With this issue of Crossroads, the WHO European Centre for Primary Health Care hopes to share some of the measures being taken in this direction and to remind readers that these are some of the important reasons to get people, patients, providers, managers and policymakers to meet at the crossroads!