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Financial Disclosure. I have the following financial interests or relationships to disclose: OMIC-Ophthalmic Mutual Insurance Company - C,L, Santen, Inc. - C,. PROMOTING AND IMPLEMENTING CLINICAL PRACTICE GUIDELINES IN DEVELOPING COUNTRIES: THE CHINA EXPERIENCE.

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financial disclosure
Financial Disclosure
  • I have the following financial interests or relationships to disclose:
    • OMIC-Ophthalmic Mutual Insurance Company - C,L,
    • Santen, Inc. - C,
slide2

PROMOTING AND IMPLEMENTING CLINICAL PRACTICE GUIDELINES IN DEVELOPING COUNTRIES:THE CHINA EXPERIENCE

ACADEMIA OPHTHALMOLOGICA INTERNATIONALIS

INAUGURAL LECTURE

OCTOBER 24, 2009

SAN FRANCISCO

slide3
RICHARD L. ABBOTT, M.DTHOMAS W. BOYDEN HEALTH SCIENCES PROFESSOR OF OPHTHALMOLOGYUNIVERSITY OF CALIFORNIA SAN FRANCISCO

SENIOR ADVISOR FOR INTERNATIONAL EDUCATION

AMERICAN ACADEMY OF OPHTHALMOLOGY

CHAIRMAN

CLINICAL GUIDELINES COMMITTEE

INTERNATIONAL COUNCIL OF OPHTHALMOLOGY

does one size fit all

DOES ONE SIZE FIT ALL?

WHAT HAVE WE LEARNED FROM CHINA AND CAN IT BE APPLIED TO OTHER COUNTRIES?

clinical practice guidelines project in china

CLINICAL PRACTICE GUIDELINES PROJECT IN CHINA

COLLABORATIVE EFFORT BETWEEN:

COS

clinical practice guidelines project in china2
CLINICAL PRACTICE GUIDELINES PROJECT IN CHINA
  • Development
  • Promotion
    • Awareness
    • Agreement
    • Adoption
    • Compliance

FOUR STEPS

awareness
AWARENESS
  • Must know that they exist
  • Must be familiar with concept
  • Must have educational programs
process for implementation
PROCESS FOR IMPLEMENTATION
  • Work through governmental, national and local societies
  • Create a “steering committee” of interested and influential leaders
slide12

THANK YOU!

谢谢!

more

key principles
KEY PRINCIPLES
  • LOCAL LEADERSHIP AND STRONG DESIRE TO IMPROVE QUALITY OF CARE (ZEALOT(S)!)
  • NEED FUNDING TO SUPPORT WORK
  • STRUCTURE OR ROAD MAP ON STEPS REQUIRED TO SUCCEED
  • INCENTIVES TO FOLLOW GUIDELINES
how are guidelines best incorporated into clinical practice
HOW ARE GUIDELINES BEST INCORPORATED INTO CLINICAL PRACTICE?
  • Create awareness through:
    • Wide dissemination
    • Education process (meetings, journals, internet)
    • 14th COS Congress in Chongqing had entire day of seminars
compliance
COMPLIANCE
  • Ease of incorporation into practice
  • Minimal change required by physician
  • Minimal cost
  • Little time constraints
compliance1
COMPLIANCE
  • Need Incentives (or Penalties)
    • Bonus
    • Lower costs
    • More patients
    • Recognition
    • Lower re-imbursement
    • Loss of licensure
government support

GOVERNMENT SUPPORT

MINISTRY OF HEALTH RECOGNITION (April, 2009)!

studies in china to examine awareness of ppps and barriers to use compliance
STUDIES IN CHINA TO EXAMINE AWARENESS OF PPPs AND BARRIERS TO USE (COMPLIANCE)
  • EYE CENTER OF PEOPLES HOSPITAL-PEKING UNIVERSITY
    • Professor Li Xiaoxin
  • TONGREN HOSPITAL – BEIJING
    • Professor Wang Ningli
glaucoma section beijing tongren eye center ningli wang

美国眼科临床指南的适用性研究Assessment of Ophthalmological Care Before and After the Introduction of Clinical Practice Guidelines in 3rd level Hospitals in Beijing

——青光眼部分(Glaucoma section)

北京同仁眼科中心

Beijing Tongren Eye Center

王宁利

Ningli Wang

20

slide21

Question 1:

Why do we have to implement CLINICAL PRACTICE GUIDELINES in China?

21

slide22

Answer:

Lack of consistent quality and evidence based diagnosis and treatment in China.

22

tongren survey result
Tongren survey result:

Most of the doctors in 3rd level hospital know about clinical guideline content.

But few doctors completely follow recommendations in their clinical work.

23

tongren hospital survey results
TONGREN HOSPITAL SURVEY RESULTS
  • GLAUCOMA (TONGREN VS PROVINCIAL HOSPITAL)
    • ONH EVALUATION FOR GLAUCOMA PT?
      • TONGREN: 100%
      • PROVINCIAL: 35%
    • INQUIRE ABOUT SYSTEMIC MECICAL HX?
      • TONGREN:98%
      • PROVINCIAL: 77%
    • TARGET PRESSURE FOR EACH PT?
      • TONGREN: 52%
      • PROVINCIAL: 6%
    • RECORD TIME OF IOP MEASURMENT?
      • TONGREN: 44%
      • PROVINCIAL: 14%
slide25

Question 2:

Why have Clinical Guidelines not been implemented in China?

25

slide26

Answer:

Current practice pattern of diagnosis & management in China difficult to meet requirements of clinical guideline

26

example of clinical guideline for angle closure glaucoma
EXAMPLE OF CLINICAL GUIDELINE FOR ANGLE CLOSURE GLAUCOMA

Gonioscopy[A:Ⅲ]

Documentation of the optic disc morphology, best performed by color stereophotography or computer based image analysis [A:Ⅱ]

Visual fieldevaluation [A:Ⅲ]

topical medicationsconstitute effective initial therapy [A:Ⅲ]

27

slide28

Example:

  • Gonioscopy
    • lens often not available
    • time-consuming
    • no re-imbursement
  • optic disc morphology
    • no computer based image analysis center
    • time-consuming
    • no re-imbursement
  • Visual field
    • lack of equipment
    • waiting period too long
    • many patients lost to follow-up
  • topical medications
    • no or limited education for patients
    • poor compliance

28

slide29

Question 3:

How do we implement clinical guidelines in China?

Require Administrative intervention?

29

slide30

Answer:

Its not easy!

High volume of patients would require more to be done for each patient!

Doctors’ work load would be increased

30

slide31

Question 4:

What can we do now?

31

slide32

Answer:

Set up a simple, convenient and efficient diagnosis & management system that can integrate with clinical guidelines

32

slide33

EX: Gonioscopy Descriptive

Static:

OD

OS

Pigment trabecular 0: No-see. ( Label in quadrant area.)

1: see

Dynamic: Delineate PAS extent and degree by line.

OD│_│ 个钟点

OD│_│ 个钟点

Modify current medical record format according to PPP

33

failure to implement guidelines
FAILURE TO IMPLEMENT GUIDELINES
  • NOT CREDIBLE TO PRACTITIONER
  • TOO COMPLEX
  • REQUIRES RESOURCES THAT ARE NOT READILY AVAILABLE
  • RADICALLY DIFFERENT FROM PREVAILING TREATMENT NORM
slide35

THANK YOU!!

THANK YOU!!