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Diabetes surveillance in the English-speaking Caribbean

Diabetes surveillance in the English-speaking Caribbean. IDB / EURODIAB Workshop, Brussels. Jan 23-25, 2011. Gina Pitts & Ian Hambleton Chronic Disease Research Centre The University of the West Indies. The right time? We run three registries Stroke Heart Cancer. Is now the time?.

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Diabetes surveillance in the English-speaking Caribbean

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  1. Diabetes surveillance in the English-speaking Caribbean IDB / EURODIAB Workshop, Brussels. Jan 23-25, 2011 Gina Pitts & Ian Hambleton Chronic Disease Research Centre The University of the West Indies

  2. The right time? • We run three registries • Stroke • Heart • Cancer Is now the time?

  3. Caribbean Cooperation in Health (CCH) “Health of the Region, is the Wealth of the Region” -Nassau Declaration 2001 Political commitment to improvedPublic Health Caribbean Commission On Health& Development 2007 Declaration Port of Spain: NCDs as Public Health Priority UN Session NCDs Sept 2011

  4. Public health initiatives… T&T

  5. And Bermuda…

  6. And Barbados…

  7. In Barbados: • Between 11 000 and 27 000 with diabetes • About 6% of population • 9% of adults • 16% of older adults • And about 22% of the elderly • Data static (and getting old) • ICSHIB (1997) • BES (2002) But diabetes data remain scarce

  8. Constraint Possible solution LIMITED FINANCES Think regionally… The Caribbean challenge “We have no money” “It’s not cost-effective” LIMITED PERSONNEL “We have no staff” LIMITED EXPERTISE “We’re not sure how”

  9. Area: 2,754,000 km2 • Land mass: • With Guyana: 9.8% • Without Guyana: 2.0% • Population (CARICOM) • With Haiti: 15,236m • Without Haiti: 6,557m The Caribbean region

  10. Bahamas: 325,000 Jamaica: 2,780,000 The Caribbean challenges Montserrat: 9,500 Barbados: 270,000 Trinidad & Tobago: 1,056,000

  11. Functions • Coordinate funding opps • Proposal development Funding A Caribbean resource centre • Coordinate regional training activities • Training existing staff • Recruitment Personnel • Resources for setup • Data management / stats Expertise

  12. Important economies of scale • A focus on training / ongoing skill transfer • In-house expertise / capacity building • Small numbers of cases: Caribbean reports A Caribbean resource centre Develop action plan A set of goals and indicators to increase Caribbean participation

  13. Diabetes surveillance:thoughts

  14. Healthcare in Barbados • Healthcare “free for all” • EIGHT polyclinics • ONE hospital • But 60% of people choose private primary care • Public tertiary care then used if really sick

  15. Key BNR considerations Must stand up to internal and external audit Data Protectors Staff, resources, training Champion stakeholders, QEH, insurance, GPs, DO registry Professional, technical and data Hardware & software Private, public, community, institutions, death registry, patients, medical staff Brand awareness, literature, website

  16. Is diabetes different? • BNR registries are “active” surveillance • BNR registries are population based – the conditions lend themselves to this. • Stroke or AMI – must go to hospital… • People with diabetes shop around • So population registry not a goal

  17. Diabetes goals • Alternative selling points: • Economic • Healthcare quality

  18. Economic goals • How much is spent on diabetes medication? • Do electronic data exist? Possibly… • Free (and so recorded) medication use • National ID • Formal arrangements for data extraction with Government • Record linkage – technical considerations

  19. Healthcare quality goals • Quality of tertiary healthcare? • Hospital Diabetes Clinic • Development of new data collection system • Linkage of system to economic data • The sickest… • Quality of primary care • A single Polyclinic • Have existing database system

  20. Potential use of data – I Clinicaloutcome, care/treatment • Baseline data for assessment of future trend • use of diagnostic tools, survival, disability • Evaluation of interventions • new/complex therapies, prevention • Access to/utilisation of health services • private vs public, rehabilitation services

  21. Potential use of data – II Clinical practice Indicate where treatment/facilities most need improvement Identify specialist training needs Provide information to MoH for optimal utilisation of scarce resources 21

  22. Operational ManagementStructure Operational Structure of BNR in 2010 Governance committees Professional Advisory Board Technical Advisory Board 22

  23. Roles and responsibilities

  24. Early challenges

  25. In QEH: Abstractors check Admission & Discharge data Medical & surgical wards Radiology & Rehab depts A&E records

  26. Outside QEH: Abstractors Bayview, District & Geriatric hospitals GP secretaries, polyclinics Imaging & rehab services Nursing homes

  27. NCD deaths per 100,000 Chronic NCDs 8 Caribbean nations in top 10

  28. Plan of action • Gap analysis • Availability of electronic information • Feasibility study • QEH diabetes clinic and Single Polyclinic • Identify and approach stakeholders • Develop working model

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