Financial Disclosure
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Transcript of Financial Disclosure
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I have the following financial interests or relationships to disclose:– OMIC-Ophthalmic Mutual Insurance
Company - C,L,– Santen, Inc. - C,
Financial Disclosure
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PROMOTING AND IMPLEMENTING CLINICAL PRACTICE GUIDELINES IN DEVELOPING COUNTRIES:
THE CHINA EXPERIENCE
ACADEMIA OPHTHALMOLOGICA INTERNATIONALISINAUGURAL LECTURE
OCTOBER 24, 2009SAN FRANCISCO
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RICHARD L. ABBOTT, M.DTHOMAS W. BOYDEN HEALTH SCIENCES PROFESSOR OF OPHTHALMOLOGY
UNIVERSITY OF CALIFORNIA SAN FRANCISCO
SENIOR ADVISOR FOR INTERNATIONAL EDUCATIONAMERICAN ACADEMY OF OPHTHALMOLOGY
CHAIRMAN CLINICAL GUIDELINES COMMITTEE
INTERNATIONAL COUNCIL OF OPHTHALMOLOGY
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DOES ONE SIZE FIT ALL?
WHAT HAVE WE LEARNED FROM CHINA AND CAN IT BE APPLIED TO
OTHER COUNTRIES?
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CLINICAL PRACTICE GUIDELINES
PROJECT IN CHINACOLLABORATIVE EFFORT
BETWEEN:
COS
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CLINICAL PRACTICE GUIDELINES PROJECT IN
CHINADEVELOPMENT PHASE
(2004-2006)
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CLINICAL PRACTICE GUIDELINES PROJECT IN
CHINA Development Promotion
– Awareness– Agreement– Adoption– Compliance
FOUR STEPS
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PROMOTION OF CLINICAL PRACTICE GUIDELINES IN
CHINA
BEIJING 2006
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AWARENESS
Must know that they exist
Must be familiar with concept
Must have educational programs
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WHAT HAVE WE LEARNED FROM CHINA AND HOW CAN IT BE APPLIED TO OTHER COUNTRIES?
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PROCESS FOR IMPLEMENTATION
Work through governmental, national and local societies
Create a “steering committee” of interested and influential leaders
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THANK YOU! 谢谢 !more
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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
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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
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Physician compliance with guideline use
is significant challenge
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COMPLIANCE Ease of incorporation into
practice
Minimal change required by physician
Minimal cost
Little time constraints
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COMPLIANCE
Need Incentives (or Penalties)– Bonus– Lower costs– More patients– Recognition
– Lower re-imbursement– Loss of licensure
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GOVERNMENT SUPPORT
MINISTRY OF HEALTH RECOGNITION (April, 2009)!
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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
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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
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Question 1:
Why do we have to implement CLINICAL PRACTICE GUIDELINES
in China?
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Answer:
Lack of consistent quality and evidence based diagnosis and treatment in China.
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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.
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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%
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Question 2:
Why have Clinical Guidelines not been implemented in
China?
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Answer:
Current practice pattern of diagnosis & management in China difficult to meet
requirements of clinical guideline
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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 field evaluation [A: ]Ⅲ
topical medications constitute effective initial therapy [A: ]Ⅲ
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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
Example:
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Question 3:
How do we implement clinical guidelines in China?
Require Administrative intervention?
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Answer: Its not easy!
High volume of patients would require more to be done for each
patient!
Doctors’ work load would be increased
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Question 4:
What can we do now?
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Answer:
Set up a simple, convenient and efficient diagnosis &
management system that can integrate with clinical
guidelines
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Modify current medical record format according to PPP
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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
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FAILURE TO IMPLEMENT GUIDELINES
NOT CREDIBLE TO PRACTITIONER
TOO COMPLEX
REQUIRES RESOURCES THAT ARE NOT READILY AVAILABLE
RADICALLY DIFFERENT FROM PREVAILING TREATMENT NORM
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THANK YOU!!THANK YOU!!