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Sergey Boytsov, State Scientific Research Institute of Organization and Information of Health Care, Russian Federation
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  • За два года наблюдения результаты стали еще более впечатляющими. Количество осложнений в группе активного лечения было в 6 раз ниже, по сравнению со стандартной терапией. Количество ОИМ можно уменьшить в 8,5 раз, ОНМК в 10 раз и тяжелых гипертонических кризов почти в 6 раз. Таким образом только Энапа и его фиксированная комбинация доказали свою эффективность по снижению развития осложнений и улучшению прогноза российских пациентов.

Sergey Boytsov, State Scientific Research Institute of Organization and Information of Health Care, Russian Federation Presentation Transcript

  • 1. Progress in NCD reduction in Russian FederationBoytsov S.National Research Center for Preventive Medicine,Мoscow
  • 2. High level of cardiovascular mortality in Russian Federation (2010 г.)Life expectancyDespite the reduction the gap is still very large: 7 years - Estonia, 8 years - of the"new" EU member states, 12 -years from the "old" members EU
  • 3. 646,7811,7801,0835,5621,0769,1836,2790,7757,8749,8746,8813,1846,1864,6907,0927,5895,4908,0864,8834,0400450500550600650700750800850900950100019911992199319941995199619971998199920002001200220032004200520062007200820092010729,32011Rosstat, 201321%2012Steady decline in the mortality of the Russian population fromcardiovascular diseases in 2003number of deaths/100 000
  • 4. Rising health care costs (per capita) and the reduction in mortalityfrom CVD•Primary care improvement•Centers of hightechnologies•Centers for stroke and ACScare•Actions for decrease inabuse by alcohol andalcoholism prevention,reduction of consumptionof tobacco, healthy lifestyler=-0,79 p=0,036r=-1,0 p=0,0001Spearman rank correlation coefficient
  • 5. Сопоставление среднедушевых доходовнаселения и смертности населения от БСКThe growth of per capita income and reduction in mortality fromdiseases of the circulatory systemr=-0,79 p=0,036Spearman rank correlation coefficient
  • 6. Growth in sales of statins and reduced mortality from CVDpacks per year Statins sellsr=-1,0 p=0,0001Spearman rank correlation coefficient
  • 7. Growth in sales of ACEI and reduced mortality from CVDACEI sellspacks per yearr=-1,0 p=0,0001Spearman rank correlation coefficient
  • 8. The decrease in cigarette sales and reduced mortality fromcardiovascular diseasesR=1,0 p=0,0001R=0,8 p=0,2Spearman rank correlation coefficient
  • 9. NCD risk factors input in population mortality in RFNCD risk factors prevalence in RFP. Marques Dying Too Young, World Bank, 2005%%
  • 10. 59,6%Reduction in the prevalence of risk factors resulted in 60% reduction inCVD mortality in Russia in 2003-2009Shalnova S ., Deev А., 2012IMPACT
  • 11. The simultaneous implementation of the three strategies for theprevention of NCDs as the main guarantee of accelerating decline ofmortalityStrategy Implementation Targetpart ofpopulation,%Input inNCDmortalitydecrease, %Time toresult,yearsPart ofexpenditures,%Population - healthy life style(programs)100 50 5-10 10High risk -population screening and RFcorrection20-30 20 4-5 30Secondaryprevention (NCDpatients)-good clinical practice-improving patientsadherence to treatment--RF correction20-30 30 4-5 60
  • 12. Prevention and control of NCDs require regulation at all levels and theimplementation of a wide range of multi-level and cross-sectoralmeasures to the full range of determinants of NCDs (from theindividual to the structural level) in order to create the conditionsnecessary for a healthy lifeThe Moscow DeclarationAdopted at the First Global Ministerial Conferenceon Healthy Lifestyles and NCD, April 2011The Government Commission for the Protection of the health ofcitizens of the Russian Federationmulti-level and cross-sectoral cooperation
  • 13. National and regional of NCD prevention programs•motivation to HLS•condition for HLS•-elements of NCD preventionsystem•stuff education•population screening•epidemiological monitoringNational program of NCD preventionRegional program of NCD preventionMunicipal program of NCD preventionRegional program of NCD preventionMunicipal program of NCD prevention Municipal program of NCD prevention
  • 14. National and regional of NCD prevention programs•motivation to HLS•condition for HLS•-elements of NCD preventionsystem•stuff education•population screening•epidemiological monitoringNational program of NCD preventionRegional program of NCD preventionMunicipal program of NCD preventionRegional program of NCD preventionMunicipal program of NCD prevention Municipal program of NCD prevention83regions – 83 programs
  • 15. Participants of cross-sectoral cooperation in NCD preventionThe Government Commission for the Protection of the health of citizensof the Russian FederationLegislative and policy structuresState,municipal andprivate healthcareMinistries anddepartmentsSocial,business andreligiousstructures
  • 16. Distinctions in a death rate from CVD between regions ofthe Russian Federation
  • 17. Воронеж Томск Санкт-Петербург Оренбург АланияВладивостокКрасноярск Ростов Самара Иваново ТюменьВологдаCкрининг в 12 регионах по 1200+400 человекОбщий анализ полученной информацииУглубленное обследование в 5 регионахСанкт-Петербург Томск Ростов Иваново ТюменьEpidemiological monitoring of risk factors for NCDin the Russian Federation (ESSE-RF)Рязань, Кемерово, ХабаровскScreening in 15 regions of 1600 (1200 + 400) peopleDifferencesin demographic, economic, climatic, geographical, ethniccharacteristics
  • 18. Information activities in healthy lifestyle modification(population strategy)- PSAs on federal and regional TV channels in prime time- Internet- FM radio advertising- School- Printed matter- Outdoor advertising- Telephone inquiry service- Mass actions
  • 19. Conditions for healthy lifestyle modification(population strategy)-Improvement of the regulatory framework-Excise tax and regulate the production of tobacco, alcohol and food products-Ensuring the availability of healthy food (production of sufficient quantities of fruitsand vegetables products with reduced fats, trans fats and salt, placing easy to readinformation about calories, fat, carbohydrates and salt in foods)- Creating conditions for daily physical activity (parks within walking distance, bikepaths, accessible sports facilities, stadiums, etc.)
  • 20. A large part of the population with coronary artery diseaseand high-riskClinical examination (screening):identify people with CAD and at high risk and tohave them treated and corrected FR
  • 21. Coverage of the population, rangingfrom 21 years 1 every 3 years (up to20 million people/ year)Correction of risk factors in theclinical examinationThe purpose - early detection NCDand their risk factorsThe precinct-territorial principle oforganizationA differentiated approach toevaluation by gender and ageFreeWithout interfering with the ongoingwork of clinicsMedico-economic assessmentmethodsThe main features of modern medical examination (screening)(high risk strategy)Two-stage
  • 22. More than24%Per 100 000NCD detection increased на 25%(high risk strategy)
  • 23. 23The increase in life expectancyIncreasing the number of years of healthy lifePresent:Future:PreventionPreventionTreatmentTreatmentHealth IllnessHealth IllnessThe real shift in priorities in public health from the treatment ofdisease to prevention and health maintenance
  • 24. 24The prevalence of tobacco use in theadult population,%The prevalence of salt intake in theadult population,%The prevalence of inadequate fruit andvegetable consumption among adults,%The prevalence of hypertension in the adultpopulation,%The prevalence of high cholesterol in adults,%Indicators project of the National Program on NCD prevention(2013-2020)
  • 25. Actual and forecasted trends of mortalityfrom the CVD, CHD, and cerebro-vascular diseasesin the Russian Federation-30,4%-26,8%-23,3%CVDCHDCerebro-vascular(per 100 000)WHO target 2013-2020:“A 25% relative reduction in overallmortality from cardiovascular diseases,cancer, diabetes, or chronic respiratorydiseases”