Lixin Jiang MD, PhD, FACC, FAHA, FESC

Transcription

1 A Demonstration Project of Health Literacy on Tackle CVDs at Rural Settings in China Lixin Jiang MD, PhD, FACC, FAHA, FESC National Center for Cardiovascular Diseases Fuwai Hospital, Chinese Academy of Medical Science

2 The Outline of the Talk What are the settings of the demonstration project? - MPP - Survey study of the PHC system How will stakeholders be partnership in this project?

3 Who Are We? NHFPC NCCD CAMS SKLCD NCRC Bio-Bank Fuwai Hospital NHFPC: National Health Family Planning Committee NCCD: National Centre of Cardiovascular Disease CAMS: Chinese Academy of Medical Science SKLCD: State Key Lab of Cardiovascular Disease NCRC: National Clinical Research Centre for Cardiovascular Disease

4 Largest CVD Clinical Service Center 2016 Annual Report PCI and angiography: 49,732 Cardiac surgical operation: 14,755 CT for coronary, aortic, etc: 61,000 Operation rooms/ Cath lab Outpatient clinics CCU

5 National CVD Research and Prevention Center NCCD Xishan Campus SKLCD Bio-bank NCRC NCCD Admin Office

6 China PEACE Millions Persons Project

7 China PEACE Million Persons Project Jointly funded by MOF & NHFPC, 300 million RMB per year Year No. province/site Total screening (10,000) Total high-risk subject (10,000) Total management (10,000) /20 40 ~ / / / / / / By 2016: 2 M screened, 0.5 M with CVD high risk managed By 2020: 5 M screened, 1M with high risk CVD to be managed

8 Organizational Structure: 31 Provinces Central Government National Ministry of finance National Health and Family Planning Commission Local Government (937) Provincial/ City Health Administrative Departments/CDC Hospitals (469) Provincial/City/District Level Primary care institutions (7674) Community Health Service Centers (2943) Township health centers / village clinics (4731)

9 MPP: Standardized Key Equipment ID card reader Electronic BPG Blood lipids detector for screening 12-lead ECG Blood kits for collecting samples

10 MPP: Standardized Blood Lipid and Glucose Testing - Portable and easy to use: suitable for population blood lipid screening - Accurate, certification from FDA, CFDA, etc. - Same standards with US National Cholesterol Education Program (NCEP) - Simultaneously complete 4 blood lipid tests: TC, TG, HDL-C, LDL-C, Glucose

11 MPP: Standardized ECG Examination Same type of ECG device Unified operation manual Original data and imagine upload to NCCD - Project-specific ECG software - Exclusive transmission network The National Central Lab for re-evaluation

12 MPP: Standardized Cardiac and Carotid Echo Standardized protocol - image acquisition - recording template Data storage and transmission - unified image format - unified naming rule Original images upload to NCCD Verification and QC in National Central Lab

13 MPP: Standardized Bio-sample Collecting for NCCD Exhaustive Operating Manual - Collection: blood and urine - SOP for sample processing Blood kits provided by NCCD - Bio markers and HbAlc test in NCCD Regularly transfer residual sample to NCCD for central verification

14 Profound Gaps in Hypertension Management Control: 4.9% Treatment: 24.7% Awareness: 38.6% Even Worse in Rural Areas Unpublished data

15 Poor Population Education Level Rural Male Urban Male Rural Female Urban Female Illiteracy rates are much higher in rural areas, and among elder or female population Over 1/3 of the rural female aged above 70 are illiterate Unpublished data

16 Nationwide Survey on Primary Health Care Jointly funded by NHFPC, MOF, NDRC & WHO Primary health care institutions Rural Urban 300 Township health centers Community health centers 200 All 31 provinces Over 3,600 PHC Institutes 2650 Village clinics Community health stations 450 Over 20,000 providers questionnaires Over 30,000 patients questionnaires

17 Data Collection: 10 Original Documents three-year employee roster three-year annual financial statement One-year Prescriptions and medical notes Medical equipment list IT system list Essential drug list and non-essential drug list Basic medical service charging standard Annual report on the completion of the National Essential Public Health Services Program Health insurance regulation issued by local government Severe mental health register data with 3-year follow up

18 Lower Medical Training Level of PHC Professionals* Rural Urban % High school + 5Y High school + 3Y High school + 5Y High school + 3Y Junior high school + 3Y Junior high school + 3Y 9 High High school and below school and below 20 0 High school + 5Y High school + 3Y High school + 5Y High school + 3Y 20 Junior high + 3Y school + 3Y 3 High school and below High school and below 74% rural professionals just only got junior/high school education plus 3-year medical training * Including physician, nurse, pharmacist, technician, village doctor Unpublished data

19 NCCD-Lancet Commission on Primary Care in China George Mensah NIH, USA Richard Horton Lancet Chief Editor Raniero Guerra MOH, Italy Harlan Krumholz Yale University Lixin Jiang NCCD Sharon-Lise Normand Harvard University Yu Wang CDC Director,China Yujuan Zhang Yunnan PHC, China

20 It s Imperative Needs to Launch Pragmatic Health Literacy Projects To Tackle CVDs Escalating Threats in Rural Settings in China

21 A Demonstration Project Funded by NHFPC, FOM, NDRC and MOST Aim Develop solutions to scale up health literacy to tackle CVDs in rural settings Timeline 2017: protocol development & kick-off meeting : project implementation and evaluation

22 Stakeholders Are the Partnership Governments Central Provincial County Township village NCCD Coordination Knowledge providing Technology and tool providing Communities Town Village A Demonstration Project In Rural Settings Solutions-driven Health providers County hospital Township centre Village clinics Media Provincial County Township village Families and individuals International Collaborators WHO Academic

23 Lower Education Level in Population Health Knowledge is Conveyed Mainly Using Cartoon, Picture with Plain Words www. yunqueyi.com APP 云鹊医

24 Lower Education Level in Population Flexible and Diverse Dissemination Tools Video, Micro Film, SMS, APP www. yunqueyi.com APP 云鹊医

25 Lower Education Level in Population Flexible and Diverse Dissemination Tools Video, Micro Film, SMS, APP www. yunqueyi.com APP 云鹊医

26 Lower Medical Training Level in PHC Professionals Adaptable and Practice-Driven Training Contents www. yunqueyi.com APP 云鹊医

27 Health Literacy Empowers Us to Tackle CVDs Threats

28 Acknowledgement - All the colleagues from WHO - All the Chinese patients - All the Chinese policy-makers - All the Chinese collaborators - All the international partners - My team, colleagues and friends - My family members. Owe my tremendous respect, gratitude and appreciation to them all