Chronic Disease Management in China
Patient Self-Management Can Overcome an Important Healthcare Gap
According to a WHO statement on January 2015, chronic non-communicable diseases (NCDs) - such as lung cancer, stroke, heart disease and diabetes - accounted for 8.6 million deaths in China in 2012. Over half of all men in the country are smokers, more than four in five adolescents do not engage in sufficient physical activity and around one in five adults have raised blood pressure.
The WHO’s recommendation of changing common unhealthy lifestyle habits: smoking, excessive alcohol consumption, unhealthy diet, and not enough physical activity to prevent millions of Chinese men and women from dying in their most productive years from diseases is laudable, but as we have seen in western cultures, this change in behavior is slow and the results have been variable. The focus of this article will be the management of patients already with NCDs.
Healthcare in China is predominantly delivered in hospitals. Even with employers now beginning to support annual health checks of their employees, the majority of patients with chronic diseases in China tend to seek treatment only when their symptoms become severe. In China’s hospitals, it is common to see women in pain from fractures caused by osteoporosis or patients with symptomatic complications of high blood sugar from diabetes that were not adequately treated.
The time spent in hospital is the only contact the majority of Chinese patients have with the healthcare system. Unless hospitalized, patients spend only a few minutes with a physician; slightly more time with a nurse and are then sent home with drugs with little or no understanding of their condition or the drugs prescribed. The chance of patients being compliant to therapy is very low. This is further complicated by the distrust patients have in doctors prescribing drugs, fueled by public scandals of bribery and payments to doctors by pharma companies.
Chronic disease management programs for conditions like heart failure and diabetes are commonplace in US. Both payers and employers cover the cost of these programs since effective management of these patients result in much lower health expenditure and improved quality of life for patients.
Once a patient with a chronic disease leaves a hospital in China, the connectivity of patients to their healthcare professional is non-existent. Hospital information systems act as fortresses making it difficult to link patients to doctors. There are a few exceptional doctors that have established websites for their own patients, but they receive no reimbursement or support from the government for time spent with patients outside the hospital.
Third-party websites are now emerging to fill this gap:
- 39net and XYWY.com provide disease information and introductions to hospital and physicians
- HAODF.com provides on-line patient consultation and the opportunity for patients to share experiences with one another
- BBS.TNBZ.com provides a patient community
- XYWY provides a host of services from family doctors for consulting and disease and medicine information sources
- Numerous Weibo sites (e.g., 39 Health and Xinlang Health) supported bypPharma and third-party organizations provide patient education and counseling
However, the information on these sites can be outdated and variable in terms of quality. One new approach that emerged from earlier work conducted by Stanford School of Medicine involves the patients’ self-management of their disease.
Chronic Disease Self-Management Program (CDSMP):
With very limited government funding for patient disease management or home healthcare, Chinese patients are forced to fend for themselves. The self-management for people with chronic disease is now emerging as a necessary part of treatment. Lay people with chronic conditions, when given detailed training, can teach the CDSMP as effectively, if not more effectively, than health professionals. The peer leaders act more as facilitators than lecturers providing weekly feedback, role model behavior and problem-solving for peer group participants.
An illustrative example of this approach in China is a program in diabetes by a well-known Beijing University Hospital that provides a peer support model for people with diabetes to achieve better self-management and health outcomes. The program involves 19 partners including 12 hospitals, 5 community health centers and 2 district CDCs. Launched in August 2013, the program aims to recruit participants from the 50,000 type 2 diabetes patients living in Beijing into peer support activities led by peer leaders to enable 4 key stakeholders (i.e., professionals, peer leaders, patients and their families) supported by social media to work together for diabetes management and support. Ultimately, the plans are to disseminate a scaled up model across the country.
Peer leaders (diabetes patients themselves) are trained by University Hospital KOLs in diabetes care and then assigned other diabetes patients to mentor. Incentives including access to experts and glucose monitoring devices appear to be sufficient to recruit peer leaders. The social support environment created by these groups appears to be an effective means of getting diabetes patients to join. The time of KOLs to train peer leaders as well as the time of project leaders to run the program itself is volunteer-based. The University physicians are doing this in addition to their full-time positions in the hospital.
Until healthcare reform in China starts to address some of the issues of patient care outside of the hospital and begins to fund disease management programs to support patients with chronic diseases, patient self-management will be critical. Pharma has a tremendous opportunity to support these type of efforts, but need to take a background role in funding because of the inherent bias perceived by Chinese patients with their involvement.
If you are interested in finding out more about patient self-management of diseases in China, you can contact me at firstname.lastname@example.org
Jeffrey Frick is the General Manager of HAVAS Life of China. With over 25 years of global experience within pharma, biotech start-ups and healthcare consulting, Jeff’s column will provide unique insights from China, comparing and contrasting China’s healthcare infrastructure and delivery to practices in the west - learning and considerations that will help pharma refine its strategy for success in the future.
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