Call for Submissions: Special Theme Issue on the Continuums of Care in Health

The term 'Continuum of Care (CoC)' has become popular in the recent past after the emergence of a 'chronic-care model and as a part of the discourse on the universal health coverage.[1,2] The term "CoC" is not a new concept, sometimes not fully understood and has many varied definitions. In 1989, Dr. Evashwick defined CoC as 'a concept involving an integrated system of care that guides and tracks patients over time through a comprehensive array of health services spanning all the levels of intensity of care'.[3,4] On the other hand, the WHO Framework on integrated people-centered health service defines CoC as the degree to which a series of discrete healthcare events are experienced by people as coherent and interconnected over time and consistent with their health needs and preferences.[5] In general, definitions of CoC include three key terms - 'comprehensive, coordinated and integrated'. These terms pertain to the process and time points in a life, levels of care or types of care.[6,7] One dimension of CoC is the seamless experience of the patients with the health system, as stated in patient-centric model. Most chronic care models emphasise harmonious transitions between different levels of care as against the existing fragmented healthcare systems that provide episodic interventions to the episodic changes in the health status of individuals. Nevertheless, the expanded concept of CoC has seven dimensions – levels, systems, types, diseases, sector, place of residence and lifecourse [Figure 1]. Across all dimensions, significant challenges exist. They include inadequate focus on upstream policy and preventive measures, poor formal referral mechanisms,[8] lack of implementation of standard workflows, high degree of sub-specialization at the cost of general practitioners,[9] uncoordinated and inadequate ambulance and patient transport systems, unorganised private sectors and lack of private–public partnership models,[10] poor integration of indigenous and complementary systems of care.[11]Figure 1: Dimensions and prerequisites for bridging continuums of care in healthFor instance, the continuum for maternal, newborn and child health care refers to continuity of individual care throughout the lifecycle (adolescence, pregnancy, childbirth, the post-natal period and childhood) and also between the places of caregiving (households and communities, outpatient and outreach services and clinical-care settings).[12] The CoC within the End TB Strategy involves integrated services, supportive systems and a patient-centered approach.[13] While conceptually complex, failures in CoC are typically represented by dropouts at each level' of 'cascade of care'. Such demonstrations have been used for hypertension,[14] tuberculosis (TB),[15] diabetes mellitus (DM),[16] AIDS[17] and leprosy,[18] etc. All of them show the high levels of dropouts at population level from testing to diagnosis to treatment to control. Invariably, this dropout at each level leads to a very poor population level coverage and control. These single disease-specific scenario is further worsened by the increasing prevalence of multi-morbidities due to increased ageing and chronic disease,[19] poor inter-programmatic integration as is seen from TB-DM integration[20] efforts or RCH and NCD programs in gestational diabetes. For some infectious diseases such as HIV and leprosy, additional factors would include stigma which plays a crucial role in seeking care and continued treatment, impacting the CoC. Interventions focusing on improving such cascades have also been done in the Indian context for hypertension,[21] hub-spoke models for St segment elevated Myocardial Infarction (STEMI) care including private sector,[22] pilots on integrating Ayurveda intervention into hypertension management.[23] While these were all done in pilot mode, large scale implementation of these pose significant challenges. To provide CoC within the existing health system in India and developing countries, reconceptualization and reorganization of health services are needed. The three most important prerequisites for such seamless movement of patients between levels/systems/sectors of care are as follows: (1) The use of information systems including digital solutions to enable cross-linkages, (2) patient transfer between health facilities and (3) financial protection. Many initiatives are ongoing in these areas in India and other countries, but significant challenges remain. Even though, we take disease specific examples, the provision of CoC is beyond individual diseases and is a core systemic issue. It is good to see that under Ayushman Bharat, among the various strategies implemented to achieve universal coverage, the gate-keeping of services at the primary care level for the delivery of comprehensive primary care is emphasized. After entering the system through the primary care level, for a seamless navigation, a clear workflow must be defined across different levels of care in public health facilities. The operational guidelines of newer health programs must ensure that these workflows are well-defined. Further, these efforts need to be supported by strengthening of primary and secondary health care services, moving towards a team approach in health care, building transition care and hospice facilities, It goes without saying that these will also require a major relook at health worker competencies, task shifting and capacity building initiatives. 'Preventive Medicine Research and Review' intends to publish a special issue on the 'Continuums of Care in Health' focusing on the dimensions, pre-requisites and strategies and other aspects highlighted above which will not only be helpful for academicians and researchers all over the world but more importantly people implementing health programs in developing countries. The special issue will have the articles which are evidence-based and would help forming informed policy and implementation strategies for ensuring CoC in the low- and middle-income country (LMIC) context, more importantly in the South-Asian context. The indicative list of topics is provided in Box 1. The manuscripts could pertain to any disease or health condition of public health interest which would lead to a deeper understanding of various aspects of CoC and planning interventions for the same. These could include review articles, case studies, commentaries and perspectives that focus on LMICs, especially in the South-Asian context. These article could be situation analysis of CoC, interventions to promote CoC, policy and regulatory aspects related to CoC, role of digital interventions. While the paper may choose to focus on a single dimension, potential authors should note that they should address the linkages within multiple components of that dimension. We invite the articles from authors in South Asia, global South and from any LMIC.Box 1: Proposed themes/topics for the special issue (indicative list)All submitted manuscripts will be subjected to standard double-blinding peer review process. Accepted articles will be available as open access. For this special issue, the authors may submit an expression of interest by 30 November 2025, and the final submission should be made by or before 31 January 2026. The manuscripts submitted after the due date may still be considered for our regular issues. The standard guidelines for authors need to be followed for the submission, with the only exception that there is no word limit for submission for this special theme issue. However, brevity is always desirable. The special theme issue is expected to be published in Mid of 2026. We hope that this special theme issue will lead to more deliberations on this critical issue of CoC in the health system, leading to better health outcomes and universal health coverage. We also acknowledge the enormity of the problem and understand that this will require continuing efforts of all of us over a sustained period.