Session 3: Ahmed Aboulghate
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Session 3: Ahmed Aboulghate

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Ahmed Aboulghate: “Developing quality indicators for the Egyptian Primary Care system”

Ahmed Aboulghate: “Developing quality indicators for the Egyptian Primary Care system”

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  • 1. Ahmed Aboulghate , MBBCh, MPhil University of Cambridge PhD student, Cambridge Overseas Scholar Developing Quality Indicators for the Egyptian Primary Care System
  • 2.  
  • 3. Egypt; background
    • Population 73 million
    • Lower-middle income country (Poverty level 16.7%)
    • Dual burden of disea se.
    National Burden of Disease NCD 74% Communicable 9% Injuries 7% Others 10% Leading contributors to National Burden of Disease Ischaemic Heart Disease 11 % Unipolar Depression 5 % Asthma, COPD 4 % Cerebrovascular Disease 4 % Respiratory Infections 3 % Cataract 3 % Adult Onset Hearing Loss 3 % Hypertensive Heart Disease 3 % Drug Use Disorders 2 % Liver Cirrhosis 2 %
  • 4. Egyptian Health Care System
    • Social insurance
          • Free for eligible patients (48% of population)
          • Employees, infants, school children, pensioners, widows
    • State run facilities
          • Everyone is eligible
          • Limited resources, low quality
    • Private sector
          • Out of pocket (60% of national health expenditure)
          • Serves all population categories
          • Varying quality and price
  • 5. 1997: Health Sector Reform Project
    • Universal coverage
    • High quality
    • Equity
    • Efficiency
    • Sustainability
          • To shift the focus of care from heavy reliance on inpatient care to a more integrated and less costly primary care model. (Berman et al, 1998).
  • 6. Reforming the Primary Care
    • Infra structure:
          • Renovating and building PC facilities
          • Today: 5500 PC facilities
    • Care providers
          • Financial and career incentives
    • Quality control
          • Accreditation
          • Pay for performance through Quality Indicators
  • 7. Current Indicators in the Egyptian Primary Care
    • Limitations of the current indicators
      • Emphasis on ‘structure’ indicators
      • ‘ Process’ indicators are vague and broadly defined
      • Scores are manually collected through inspection visits
    Type Number of indicators included Total 34 Structure 25 Process 6 Outcome 3
  • 8. Aims of the study
    • NOT TO : Copy and Paste indicators (e.g. QOF)
    • BUT TO : Transfer technologies and methods
    • Methodology
    • Choose the medical conditions
    • Develop indicators for them
    • Pilot the new indicators
  • 9. 1. Choosing the conditions
    • The most common conditions presenting to primary care units
          • Primary data collection
          • >2000 patients
          • 12 primary care units
    • National Burden of Disease
    • Basic Benefit Package
  • 10. 2. Developing the indicators
    • The RAND/UCLA appropriateness method
          • Literature and guidelines review
          • Developing preliminary set of indicators
          • Rating the indicators by a group of local experts
          • Panel meeting to discuss and re-rate the indicators
    Indicator Quality of evidence References Benefits/ summary Necessity Validity Patients with CAD should be advised to take aspirin at a dose of 75-100 mg/day unless contraindicated I Yusuf et al, 1998 ATC, 1994 Absolute reduction in vascular events of 5% (1-9) (1-9)
  • 11. 3. Piloting the indicators
    • Extracting Indicators scores from patients records
    • Testing the time and resources required to extract the indicators
    • Testing the inter-rater reliability
  • 12. Opportunities
    • Measure the feasibility of applying the new indicators
    • Propose modifications to the electronic recording system to implement automated indicator score calculation
    • Building a culture of Evidence Informed policy making
  • 13. Thank you