Reconfiguring primary care for the era of chronic diseases

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IFPMA Geneva Pharma Forum, Putting NCDs into Focus, Dr. Margaret Kruk, Mailman School of Public Health, Columbia University (4 February 2013)

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Reconfiguring primary care for the era of chronic diseases

  1. 1. Reconfiguring primary care for the era of chronic diseases Margaret E. Kruk, MD MPH Columbia University Mailman School of Public Health February 4, 2013
  2. 2. A few numbers• 44 million• 80%• 1 in 3 1
  3. 3. A few numbers• 44 million deaths from CVD, diabetes, cancer, chronic respiratory disease in 2010• 80% of NCD deaths in low- and middle income countries• 1 in 3 NCD deaths in LMICs are under the age of 60 2
  4. 4. Shifting epidemiology: Brazil 1930-2004PAHO/WHO. Scaling up Primary Health Care Interventions for Chronic Disease Prevention and Control. 35th Annual InternationalConference of the Global Health Council. Washington, DC: PAHO/WHO; 2008. 3
  5. 5. Primary care• first-contact care• promotes ease of access• care for a broad range of health needs• continuity• involvement of family and community 4
  6. 6. Primary care• first-contact care• promotes ease of access Ideal• care for a broad range of platform health needs for• continuity tackling NCDs• involvement of family and community 5
  7. 7. Many NCD services can be provided in primary care• Primary prevention: Hepatitis B and HPV immunization, smoking cessation• Diagnosis: BP, cholesterol, glucose testing, mammography, opportunistic screening for depression 6
  8. 8. Many NCD services can be provided in primary care• Management: CVD therapy, inhaled corticosteroids/beta-2 agonists, hypoglycemics, antidepressants, retinopathy screening• Palliation: home-based care for terminal cancer, opiate therapy 7
  9. 9. But primary care in LMICs not able to meet NCD challengeHistoricorientation toinfectiousdiseases andmaternal andchild health 8
  10. 10. But primary care in LMICs not able to meet NCD challengeChronicunderfundingand humanresource crisis 9
  11. 11. The NCD imperative• Integration and continuity of care• Innovative service delivery• Inclusion of patients and communities• Information and communicationand• Evaluation for accountability 10
  12. 12. Integration and continuity• Reorganize of care delivery with patient as the central node• Move from vertical programming to investing in health systems• Borrow from HIV care: a chronic, communicable disease• Team based care (e.g., Brazil’s family health teams)• Integration with referral care 11
  13. 13. Innovative service delivery• Shift tasks to non-physicians (Cameroon’s nurse-led CVD program)• Use algorithms and clinical guidelines• Diagnose at the point of care (e.g., Peru’s see and treat cervical cancer screening) 12
  14. 14. Inclusion of patients and communities• Reduce financial barriers to care for NCDs (e.g., diabetes in Cameroon, CCTs in Mexico)• Improve fit between patient expectations and reality in health service provision• Reach out to community and engage peers 13
  15. 15. Information and communication• Use mobile phones to promote healthy lifestyles (e.g., smoking cessation in Britain)• Use mobile and internet technology to bridge distance between home and primary health clinic (e.g., text test results, appt reminders) 14
  16. 16. Evaluation is a crucial underpinning• Learning what works across different settings• Making necessary course corrections• Enhancing accountability to funders and patients 15
  17. 17. Need for a reset of primary careto realize its potential to tackle NCDs in low- and middle- income countries 16
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