Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI)

BMC Medicine

Paul E Farmer⁵  David C Mabey¹  Kwonjune Seung⁵  Tom Nicholson²  Peter Drobac⁵  Neil Gupta⁵  Manzi Anatole²  Sandy Gove⁴  Stephen D Lawn¹  Andrew Ellner⁵  Ashwin Vasan³ 

[1] Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK;Partners In Health, Kigali, Rwanda;Department of Medicine, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA;IMAI-IMCI Alliance, San Francisco, CA, USA;Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA

关键词: IMAI;    Health systems;    Health care delivery;    Quality improvement;    Integration;    Integrated management;    Primary care;   

Others  :  855169
DOI  :  10.1186/1741-7015-12-6

 received in 2013-08-30, accepted in 2013-12-17,  发布年份 2014

【 摘 要 】

Background

More than three decades after the 1978 Declaration of Alma-Ata enshrined the goal of ‘health for all’, high-quality primary care services remain undelivered to the great majority of the world’s poor. This failure to effectively reach the most vulnerable populations has been, in part, a failure to develop and implement appropriate and effective primary care delivery models. This paper examines a root cause of these failures, namely that the inability to achieve clear and practical consensus around the scope and aims of primary care may be contributing to ongoing operational inertia. The present work also examines integrated models of care as a strategy to move beyond conceptual dissonance in primary care and toward implementation. Finally, this paper examines the strengths and weaknesses of a particular model, the World Health Organization’s Integrated Management of Adolescent and Adult Illness (IMAI), and its potential as a guidepost toward improving the quality of primary care delivery in poor settings.

Discussion

Integration and integrated care may be an important approach in establishing a new paradigm of primary care delivery, though overall, current evidence is mixed. However, a number of successful specific examples illustrate the potential for clinical and service integration to positively impact patient care in primary care settings. One example deserving of further examination is the IMAI, developed by the World Health Organization as an operational model that integrates discrete vertical interventions into a comprehensive delivery system encompassing triage and screening, basic acute and chronic disease care, basic prevention and treatment services, and follow-up and referral guidelines. IMAI is an integrated model delivered at a single point-of-care using a standard approach to each patient based on the universal patient history and physical examination. The evidence base on IMAI is currently weak, but whether or not IMAI itself ultimately proves useful in advancing primary care delivery, it is these principles that should serve as the basis for developing a standard of integrated primary care delivery for adults and adolescents that can serve as the foundation for ongoing quality improvement.

Summary

As integrated primary care is the standard of care in the developed world, so too must we move toward implementing integrated models of primary care delivery in poorer settings. Models such as IMAI are an important first step in this evolution. A robust and sustained commitment to innovation, research and quality improvement will be required if integrated primary care delivery is to become a reality in developing world.

【 授权许可】

   
2014 Vasan et al.; licensee BioMed Central Ltd.

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