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1、I have the following financial interests or relationships to disclose: OMIC-Ophthalmic Mutual Insurance Company - C,L, Santen, Inc. - C,Financial Disclosure,PROMOTING AND IMPLEMENTING CLINICAL PRACTICE GUIDELINES IN DEVELOPING COUNTRIES: THE CHINA EXPERIENCE,ACADEMIA OPHTHALMOLOGICA INTERNATIONALIS
2、INAUGURAL LECTURE OCTOBER 24, 2009 SAN FRANCISCO,RICHARD L. ABBOTT, M.D THOMAS W. BOYDEN HEALTH SCIENCES PROFESSOR OF OPHTHALMOLOGY UNIVERSITY OF CALIFORNIA SAN FRANCISCO,SENIOR ADVISOR FOR INTERNATIONAL EDUCATION AMERICAN ACADEMY OF OPHTHALMOLOGY CHAIRMAN CLINICAL GUIDELINES COMMITTEE INTERNATIONAL
3、 COUNCIL OF OPHTHALMOLOGY,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,COLLABORATIVE EFFORT BETWEEN:,COS,CLINICAL PRACTICE GUIDELINES PROJECT IN CHINA,DEVELOPMENT PHASE (2004-2006),CLINICAL PRACTICE GUI
4、DELINES PROJECT IN CHINA,Development Promotion Awareness Agreement Adoption Compliance,FOUR STEPS,PROMOTION OF CLINICAL PRACTICE GUIDELINES IN CHINA,BEIJING 2006,AWARENESS,Must know that they exist Must be familiar with concept Must have educational programs,WHAT HAVE WE LEARNED FROM CHINA AND HOW C
5、AN IT BE APPLIED TO OTHER COUNTRIES?,PROCESS FOR IMPLEMENTATION,Work through governmental, national and local societies Create a “steering committee” of interested and influential leaders,THANK YOU!,谢谢! more,KEY PRINCIPLES,LOCAL LEADERSHIP AND STRONG DESIRE TO IMPROVE QUALITY OF CARE (ZEALOT(S)!) NE
6、ED 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?,Create awareness through: Wide dissemination Education process (meetings, journals, internet) 14th COS Congress in Chongqing had
7、entire day of seminars,Physician compliance with guideline use is significant challenge,COMPLIANCE,Ease of incorporation into practice Minimal change required by physician Minimal cost Little time constraints,COMPLIANCE,Need Incentives (or Penalties) Bonus Lower costs More patients Recognition Lower
8、 re-imbursement Loss of licensure,GOVERNMENT SUPPORT,MINISTRY OF HEALTH RECOGNITION (April, 2009)!,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,20,美国
9、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,Question 1: Why do we have to implement CLINICAL PRACTICE GUIDELINES in Chi
10、na?,21,22,Answer: Lack of consistent quality and evidence based diagnosis and treatment in China.,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 SURV
11、EY 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%,25,Qu
12、estion 2: Why have Clinical Guidelines not been implemented in China?,26,Answer: Current practice pattern of diagnosis & management in China difficult to meet requirements of clinical guideline,EXAMPLE OF CLINICAL GUIDELINE FOR ANGLE CLOSURE GLAUCOMA,Gonioscopy A: Documentation of the optic disc mor
13、phology, best performed by color stereophotography or computer based image analysis A: Visual field evaluation A: topical medications constitute effective initial therapy A:,27,28,Gonioscopy lens often not available time-consuming no re-imbursement optic disc morphology no computer based image analy
14、sis 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:,29,Question 3: How do we implement clinical guidelines in China? Require Administrative
15、 intervention?,30,Answer: Its not easy! High volume of patients would require more to be done for each patient! Doctors work load would be increased,31,Question 4: What can we do now?,32,Answer: Set up a simple, convenient and efficient diagnosis & management system that can integrate with clinical
16、guidelines,Modify current medical record format according to PPP,33,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,FAILURE TO IMPLEMENT GUIDELINES,NOT CREDIBLE TO PRACTITIONER TOO COMPLEX REQUIRES RESOURCES THAT ARE NOT READILY AVAILABLE RADICALLY DIFFERENT FROM PREVAILING TREATMENT NORM,THANK YOU!,THANK YOU!,
