Chronic Disease
Non-communicable diseases (NCDs, chronic diseases such as hypertension and diabetes) are difficult to control. Proper management requires ongoing monitoring, extensive history taking, medication titration and a healthy dose of patient education. This differs from the management of infectious diseases which is often a single visit with a brief history and a short course of medication (such as antibiotics). As Viet Nam has become more developed, the leading cause of death has moved from infections to cardiovascular disease – a pattern common in developing countries. Unfortunately, in many rural areas of the country, the management style hasn’t changed. Patients with NCDs like hypertension and diabetes have very short initial visits (on the order of a minute). They get a small amount of medication (like 10 days of an antihypertensive) and followup is scarce. This has led to some of the daunting statistics we saw on our initial assessment of the problem – less than 5% of patients were at a target blood pressure or blood sugar and 10 to 15% of patients presented with a stroke as their initial manifestations of hypertension. We have been working many years to develop a model that can change the “culture” of the commune health centers that makes it more amenable to NCD management. This involves a training package, protocol for the diagnosis and management of NCDs in lower resource settings, and a patient booklet that allows for effective monitoring of disease. We were recognized by the World Health Organization and they collaborated with us to test our model in northern Viet Nam. Our model improved patient and physician knowledge of NCDs and risk factors and improved control of diabetes and hypertension at a low cost. We are currently testing a modified version our model in a more rural setting and working with the government to use it countrywide. |
|