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Global Critical Care: Moving Forward in Resource-Limited Settings.

ABSTRACT: Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and institutional obstacles to implementation of life-saving interventions. Potential solutions include the development of common definitions for intensive care unit (ICU), intensivist, and intensive care to create a universal ICU organization framework; development of educational programs for capacity building of health care professionals working in resource-limited settings; global prioritization of epidemiologic and clinical research in resource-limited settings to conduct timely and ethical studies in response to emerging threats; adaptation of international guidelines to promote implementation of evidence-based care; and strengthening of health systems that integrates these interventions. This manuscript reviews the field of global critical care, barriers to safe high-quality care, and potential solutions to existing challenges. We also suggest a roadmap for improving the treatment of critically ill patients in resource-limited settings.

SUBMITTER: Diaz JV

PROVIDER: S-EPMC7052346 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Global Critical Care: Moving Forward in Resource-Limited Settings.

Diaz Janet V JV Riviello Elisabeth D ED Papali Alfred A Adhikari Neill K J NKJ Ferreira Juliana C JC

Annals of global health 20190122 1

Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and institutional obstacles to implementation of life-saving interventions. Potential ...[more]

PMID: 30741504

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Project description:BackgroundThe early identification of individuals at high risk for adverse outcomes by a Comprehensive Geriatric Assessment (CGA) in resource-limited primary care settings enables tailored treatments, however, the evidence concerning its benefits are still controversial. The main objective of this study was to examine the validity and reliability of the "Multidimensional Assessment of Older People in Primary Care (AMPI-AB)", a CGA for primary care in resource-limited settings.MethodsLongitudinal study, with median follow-up time of 16?months. Older adults from a public primary care unit in São Paulo, Brazil, were consecutively admitted. Reliability was tested in a sample from a public geriatric outpatient clinic. Participants were classified by the AMPI-AB score as requiring a low, intermediate or high complexity of care. The Physical Frailty Phenotype was used to explore the AMPI-AB's concurrent validity. Predictive validity was assessed with mortality, worsening of the functional status, hospitalizations, emergency room (ER) visits and falls. The area under the ROC curve and logistic regression were calculated for binary outcomes, and a Cox proportional hazards model was used for survival analysis.ResultsOlder adults (n?=?317) with a median age of 80 (74-86) years, 67% female, were consecutively admitted. At the follow-up, 7.1% of participants had died, and increased dependency on basic and instrumental activities of daily living was detected in 8.9 and 41.1% of the participants, respectively. The AMPI-AB score was accurate in detecting frailty (area under the ROC curve?=?0.851), predicted mortality (HR?=?1.25, 95%CI?=?1.13-1.39) and increased dependency on basic (OR?=?1.26, 95%CI?=?1.10-1.46) and instrumental (OR?=?1.22, 95%CI?=?1.12-1.34) activities of daily living, hospitalizations (OR?=?2.05, 95%CI?=?1.04-1.26), ER visits (OR?=?1.20, 95%CI?=?1.10-1.31) and falls (OR?=?1.10, 95%CI?=?1.01-1.20), all models adjusted for sex and years of schooling. Reliability was tested in a sample of 52 older adults with a median age of 72 (85-64) years, 63.5% female. The AMPI-AB also had good interrater (ICC?=?0.87, 95%CI?=?0.78-0.92), test-retest (ICC?=?0.86, 95%CI?=?0.76-0.93) and proxy reliability (ICC?=?0.84, 95%CI?=?0.67-0.93). The Cronbach's alpha was 0.69, and the mean AMPI-AB administration time was 05:44?±?02:42?min.ConclusionThe AMPI-AB is a valid and reliable tool for managing older adults in resource-limited primary care settings.

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Global Critical Care: Moving Forward in Resource-Limited Settings.

Publications

Global Critical Care: Moving Forward in Resource-Limited Settings.

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