Table 1.
Barriers to evidence-based cardiovascular disease health care at the patient, health-care provider and health system/policy level, prioritized by country income strata.
| Barrier | Example | Country Income Strata |
|---|---|---|
| Patient 18: | ||
| Availability, access, and costs (External) | Lack of health insurance | Both HIC and LMIC |
| Knowledge (Internal) | Asymptomatic thus question need for ongoing treatment | Both HIC and LMIC |
| Beliefs (Internal) | Alternative/traditional medicine | LMIC > HIC |
| Memory (Internal) | Affects adherence to recommended therapies | Both HIC and LMIC |
| Side effects to medications (Internal) | Whether real or perceived (myalgia, cough, etc.) | Both HIC and LMIC |
| Health Care Provider 18, 21: | ||
| Knowledge | Familiarity and awareness of management options | LMIC: Standards of education, ongoing options for continued medical education |
| Attitudes | Lack of agreement with guidelines, outcome expectancy, self-efficacy, motivation and treatment inertia | LMIC: Conflicting opinions regarding alternative medicine |
| Behavior | External or environmental factors limiting management (time, resources, reimbursement) | LMIC>HIC |
| Health System/Policy 22: | ||
| Health Care Financing System | Low priority in national budgets: competing political agendas (military, other medical conditions such as HIV, etc.). Limited universal health care coverage. | LMIC>HIC |
| Medical Products and Technologies | Lacking infrastructures for stocking pharmacies with evidence-based generic medications. Poor affordability of essential medications, even when they are generic. | LMIC>HIC |
| Leadership/Governance | Low Priority for cardiovascular disease prevention: lack of effective screening programs, smoking cessation programs, safe environments for exercise, high costs for healthy foods | Both HIC and LMIC |
| Health Workforce | Limited number of adequately trained physicians and health care professionals | LMIC>HIC |
| Health Information System and Research | Limited health system infrastructures to ensure monitoring of health determinants, performance and health status | LMIC>HIC |
| Service Delivery | Efficient delivery of effective and safe interventions | Both HIC and LMIC |
HIC=high-income countries; LMIC=low- and middle-income countries.