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dc.contributor.authorVasan, Ashwinen_US
dc.contributor.authorEllner, Andrewen_US
dc.contributor.authorLawn, Stephen Den_US
dc.contributor.authorGove, Sandyen_US
dc.contributor.authorAnatole, Manzien_US
dc.contributor.authorGupta, Neilen_US
dc.contributor.authorDrobac, Peteren_US
dc.contributor.authorNicholson, Tomen_US
dc.contributor.authorSeung, Kwonjuneen_US
dc.contributor.authorMabey, David Cen_US
dc.contributor.authorFarmer, Paul Een_US
dc.date.accessioned2014-03-11T13:24:57Z
dc.date.issued2014en_US
dc.identifier.citationVasan, A., A. Ellner, S. D. Lawn, S. Gove, M. Anatole, N. Gupta, P. Drobac, et al. 2014. “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 12 (1): 6. doi:10.1186/1741-7015-12-6. http://dx.doi.org/10.1186/1741-7015-12-6.en
dc.identifier.issn1741-7015en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11879463
dc.description.abstractBackground: 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.en
dc.language.isoen_USen
dc.publisherBioMed Centralen
dc.relation.isversionofdoi:10.1186/1741-7015-12-6en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895758/pdf/en
dash.licenseLAAen_US
dc.subjectPrimary careen
dc.subjectIntegrated managementen
dc.subjectIntegrationen
dc.subjectQuality improvementen
dc.subjectHealth care deliveryen
dc.subjectHealth systemsen
dc.subjectIMAIen
dc.titleIntegrated 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)en
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalBMC Medicineen
dash.depositing.authorEllner, Andrewen_US
dc.date.available2014-03-11T13:24:57Z
dc.identifier.doi10.1186/1741-7015-12-6*
dash.authorsorderedfalse
dash.contributor.affiliatedEllner, Andrew
dash.contributor.affiliatedFarmer, Paul


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