Implementation research on measuring quality in primary care: balancing national needs with learning from the Eastern Mediterranean Region.

BACKGROUND: Universal Health Coverage (UHC) is a core element of ensuring healthy lives, marking the third Sustainable Development Goal. It requires providing quality primary health-care (PHC) services. Assessment of quality of care considering a wide variety of contexts is a challenge. This study lists practical indicators to enhance the quality of PHC. OBJECTIVES: Demonstrating quality indicators for PHC that are feasible, comprehensive and adaptable to wide array of health systems and resource settings. METHODS: We applied the research framework: Exploration, Preparation, Implementation and Sustainment. Exploration included a scoping review to identify quality indicators. Preparation included an eDelphi to refine the primary indicators' list. A panel of 27 experts reviewed the list that was later pilot tested in PHC facilities. The outcomes were presented to two further expert consultations, to refine indicators and plan for broader testing. Implementation included testing the indicators through a five-step process in 40 facilities. A regional consultation in May 2016 discussed the testing outcomes. RESULTS: Initial efforts identified 83 quality indicators at the PHC level that were then refined to a 34-indicator list covering the six domains of quality. A toolkit was also developed to test the feasibility of each indicator measurement, data availability, challenges and gaps. Pilot testing provided insight into modifying and adding some indicators. Wide variability was encountered within and in between facilities, and timely initiation of antenatal care, for example, ranged 31-90% in Oman and 11-98% in Tunisia. Indicators were highly feasible, and 29 out of 34 were measured in 75% of facilities or more. While challenges included gaps in capacity for data collection, the tool showed high adaptability to the local context and was adopted by countries in the Eastern Mediterranean Region (EMR) including Libya, Oman, Iran, Pakistan, Sudan and Palestine. Stakeholders agreed on the high relevance and applicability of the proposed indicators that have been used to inform improvement. CONCLUSION: A cross-regional set of 34 quality indicators of PHC in the EMR was developed and adopted by a diverse group of countries. The toolkit showed high feasibility in pilot testing reflecting the practicality needed to encourage local uptake and sustainability. The core quality indicators are highly adaptable to different local and regional contexts regardless of current PHC strength or available resources. Continuous evaluation and sharing lessons of implementation and use are needed to ascertain the indicators' effectiveness in driving improvements in PHC and to refine and strengthen the evidence supporting the set of indicators for wider adoption.

Resveratrol Supplementation in Patients with Non-Alcoholic Fatty Liver Disease: Systematic Review and Meta-analysis.

BACKGROUND: Resveratrol is a potential treatment option for management of non-alcoholic fatty liver disease (NAFLD) due to its anti-inflammatory, antioxidant properties, and calorie restriction-like effects. We aimed to synthesise evidence from published randomized clinical trials (RCTs) about the efficacy of resveratrol in the management of NAFLD. METHODS: A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central was conducted using relevant keywords. Records were screened for eligible studies and data were extracted and synthesized using Review Manager Version 5.3 for windows. Subgroup analysis and sensitivity analysis were conducted. RESULTS: Four RCTs (n=158 patients) were included in the final analysis. The overall effect estimates did not favor resveratrol group in terms of: serum ALT (MD -2.89, 95%CI [-15.66, 9.88], p=0.66), serum AST (MD -3.59, 95%CI [-13.82, 6.63], p=0.49), weight (MD -0.18, 95%CI [-0.92, 0.55], p=0.63), BMI (MD -0.10, 95 %CI [-0.43, 0.24], p=0.57), blood glucose level (MD -0.27, 95%CI [-0.55, 0.01], p=0.05), insulin level (MD -0.12, 95%CI [-0.69, 0.46], p=0.69), triglyceride level (MD 0.04, 95%CI [-0.45, 0.53], p=0.87), and LDL level (MD 0.21, 95%CI [-0.41, 0.83], p=0.51). Pooled studies were heterogeneous. CONCLUSION: Current evidence is insufficient to support the efficacy of resveratrol in the management of NAFLD. Resveratrol does not attenuate the degree of liver fibrosis or show a significant decrease in any of its parameters.