Evidence map›Paper›PMID 25121789›Full record

SynthesisPloS one2014

Task shifting for non-communicable disease management in low and middle income countries--a systematic review.

Rohina Joshi, Mohammed Alim, Andre Pascal Kengne, Stephen Jan, Pallab K Maulik, David Peiris, Anushka A Patel

Registry-linked trialAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03376607 (Community- and mHealth-Based Integrated Management of Diabetes in Primary Healthcare in Rwanda), which is not on this map. Cited by 354 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
354citing papers in PubMed, 15 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03376607 naunknown statusnot on this mapstarted 2019, after this paper: background citation

Community- and mHealth-Based Integrated Management of Diabetes in Primary Healthcare in Rwanda: The D²Rwanda Study

TypeinterventionalSponsorUniversity of AarhusRan2019 to 2021Enrolled209ConditionsDiabetes Mellitus, Telemedicine, Community Health WorkersArmsHBCP programme, mobile health application
3 · Its place in the literature

Who cites it

354 citing papers in PubMed, 15 syntheses or guidelines pooled it.

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  13. BMJ open · 2021
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294 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Rohina JoshiThe George Institute for Global Health, Sydney, Australia; University of Sydney, Sydney, Australia.
Mohammed AlimThe George Institute for Global Health, Hyderabad, India.
Andre Pascal KengneMedical Research Council, Cape Town, South Africa.
Stephen JanThe George Institute for Global Health, Sydney, Australia; University of Sydney, Sydney, Australia.
Pallab K MaulikThe George Institute for Global Health, Hyderabad, India; University of Oxford, Oxford, United Kingdom.
David PeirisThe George Institute for Global Health, Sydney, Australia; University of Sydney, Sydney, Australia.
Anushka A PatelThe George Institute for Global Health, Sydney, Australia; University of Sydney, Sydney, Australia.

Funding

DBT-Wellcome Trust India Alliance IA/I/13/1/500879
6 · The paper itself

Abstract

backgroundOne potential solution to limited healthcare access in low and middle income countries (LMIC) is task-shifting- the training of non-physician healthcare workers (NPHWs) to perform tasks traditionally undertaken by physicians. The aim of this paper is to conduct a systematic review of studies involving task-shifting for the management of non-communicable disease (NCD) in LMIC.

methodsA search strategy with the following terms "task-shifting", "non-physician healthcare workers", "community healthcare worker", "hypertension", "diabetes", "cardiovascular disease", "mental health", "depression", "chronic obstructive pulmonary disease", "respiratory disease", "cancer" was conducted using Medline via Pubmed and the Cochrane library. Two reviewers independently reviewed the databases and extracted the data.

findingsOur search generated 7176 articles of which 22 were included in the review. Seven studies were randomised controlled trials and 15 were observational studies. Tasks performed by NPHWs included screening for NCDs and providing primary health care. The majority of studies showed improved health outcomes when compared with usual healthcare, including reductions in blood pressure, increased uptake of medications and lower depression scores. Factors such as training of NPHWs, provision of algorithms and protocols for screening, treatment and drug titration were the main enablers of the task-shifting intervention. The main barriers identified were restrictions on prescribing medications and availability of medicines. Only two studies described cost-effective analyses, both of which demonstrated that task-shifting was cost-effective.

conclusionsTask-shifting from physicians to NPHWs, if accompanied by health system re-structuring is a potentially effective and affordable strategy for improving access to healthcare for NCDs. Since the majority of study designs reviewed were of inadequate quality, future research methods should include robust evaluations of such strategies.

Indexed as

Disease ManagementCost-Benefit AnalysisDelivery of Health CareHumansIncomeObservational Studies as TopicPovertyRandomized Controlled Trials as TopicWork

Identifiers

PMID25121789
PMCPMC4133198

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.