CVD is the leading cause of mortality worldwide, accounting for 30% of deaths, with the vast majority of these in low and middle income countries. CVD is largely preventable, and straightforward cost-effective measures could mitigate intolerable increases in disease burden in the future. However, where health budgets are overstretched and health systems lacking, this can be a challenge. CVD is high on the global health agenda, particularly since the UN high level meeting on non-communicable diseases in New York in September 2011.
The challenge is to develop a systematic, feasible and effective approach to chronic care for patients with CVD. COMDIS HSD recently developed a package of care for cardiovascular disease (CVD), hypertension and type II diabetes in low and middle income countries. This package of care has great potential to be scaled up across different countries and contexts, particularly given the large number of people affected by these diseases. Currently, it is being adapted in China, Tanzania and Pakistan and it is expected that other countries will follow shortly.
The package of care consists of a number of tools, specifically a Case Management Desk Guide for Clinicians and a Health Educator Desk Guide for Health Workers. Other supporting materials include training modules and patient monitoring tools such as patient registers which help to track patient care. These are all targeted at the primary care setting of local health facilities and outpatient departments. Tools for healthcare workers help to implement standardised quality procedures, assist effective screening, diagnosis and management of CVD and associated diseases in primary healthcare in low resource settings.
Case Management Desk Guide for Clinicians
This is a generic desk guide for the management of cardiovascular disease, diabetes and hypertension in adults in low-middle income countries. These guidelines and related tools are being adapted to the local health service context in country by the Ministry of Health and NGO partners through a working group process. This process should acknowledge available resources, including; staff, drugs, basic equipment, tests (and units) prior to pilot, evaluation and scale-up in country. This desk guide is a concise “quick reference” for doctors, clinical officers, paramedics, nurses and counsellors to use when providing routine care and health education to all patients. The initial assessment pages are designed for use with any adult who presents at a primary care facility e.g. health centre or district hospital outpatient department. The objective is to enable effective opportunistic screening, diagnosis and treatment of patients with chronic noncommunicable diseases, in particular, cardiovascular disease, type 2 diabetes mellitus, hypertension and underlying risk factors. The desk guide clearly indicates when other guidelines should be used, i.e. when the management of disease, such as acute illness, is not within the scope of this guide. It provides a systematic approach to the monitoring of patients with these diseases and the prevention and identification of complications. It clearly indicates when referral to district hospital and assessment by a more senior clinician is appropriate, in conjunction with continuing routine care at the nearest health unit. It will help to educate patients about lifestyle measures and specific treatments so individuals can take responsibility for their own care. This document only includes brief lifestyle education messages and will be accompanied by a more detailed guide on lifestyle advice and treatment support, for use by the health educator/clinician. This desk guide incorporates recommendations from WHO “Package of Essential Noncommunicable Disease Interventions (PEN) for Primary Health Care” and the IDF Global Guidelines for Type 2 Diabetes and has been produced by thorough review of current guidelines and relevant published literature.
Health Educator Desk Guide for Health Workers
This desk guide will support the health worker to briefly discuss key messages related to lifestyle change, disease education and adherence to clinic appointments and medication with each patient, following an initial assessment, diagnosis and case management. The guide focuses on patient adherence and lifestyle assessment. It will enable the health educator to facilitate behaviour change, through mechanisms such as delivering key educational messages and the development of individual action plans. An education leaflet has also been developed. Once adapted, this should be given to patients and used throughout each appointment with the health educator as a prompt. It is emphasised that at each appointment, the health educator should review progress, encourage all efforts to change behaviour, reemphasise key messages and decide whether other behaviours can also be targeted, giving assistance and guidance in doing so. Individual goals should be reviewed and revised to reflect progress. NOTE: Whilst every effort has been taken to produce guidance according to best available evidence, interpretation and implementation should be undertaken in conjunction with clinician judgment.
Click on the links below for the desk guides
CVD generic desk guide
Health Educator Desk Guide