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Implementation of World Health Organization Package of Essential Noncommunicable Disease Interventions ( WHO PEN ) for Primary Health Care in Low‐Resource Settings: A Policy Statement From the World Hypertension League

Implementation of World Health Organization Package of Essential Noncommunicable Disease... POLICY STATEMENT FROM THE WORLD HYPERTENSION LEAGUE Implementation of World Health Organization Package of Essential Noncommunicable Disease Interventions (WHO PEN) for Primary Health Care in Low-Resource Settings: A Policy Statement From the World Hypertension League 1 2 3 4 5 Xin H. Zhang, MD; Liu Lisheng, MD; Norm R.C. Campbell, MD; Mark L. Niebylski, MD, PhD; Peter Nilsson, DrPH; Daniel T. Lackland, PhD, MBA, MS; for the World Hypertension League From the Medicine, Beijing Hypertension League Institute, Haidian District, Beijing, China; Beijing Hypertension League Institute, Haidian District, Beijing, China; Departments of Medicine, Physiology and Pharmacology and Community Health Sciences, O’Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Clinical Cardiovascular Research, Lund University, Dept 4 5 Clinical Sciences, Skane University Hospital, Malmo, Sweden; Department of Neurosciences, Medical University of South Carolina, Charleston, SC; and World Hypertension League, Corvallis, MT Noncommunicable diseases (NCDs) accounted for more and kidney disease through integrated management of than two thirds of total deaths globally and 40% of hypertension and diabetes. Once primary healthcare NCD deaths in patients younger than 70 years. The workers develop the skills to effectively implement the majority (82%) of the premature deaths were from low- protocol, the portfolio can be expanded to other NCDs. and middle-income countries. Cost-effective interven- The feasibility of the protocol for management of tions for the prevention and management of NCDs are hypertension and diabetes has been tested in a commu- available. However, these interventions are often not nity-based prevention and control project that ran from accessible to the poor, especially in resource-constrained April 2013 to August 2014 in China. More than 2000 settings. Because of the lack of appropriate prevention primary care physicians from 200 community health- and care, many people are suffering unnecessarily from care centers in eight regions attended training sessions preventable NCDs and associated complications. based on the WHO PEN protocol. Preliminary analysis The World Health Organization developed the Pack- of data from the screening of 300,000 residents age of Essential Noncommunicable Disease Interven- indicated that the awareness, treatment, and control tions (PEN) for Primary Health Care in Low-Resource rate of hypertension improved continuously over the Settings, referred to herein as WHO PEN. It is a course of the project and the overall risk of cardiovas- prioritized set of cost-effective interventions, tools, and cular disease decreased. Concurrently, physicians aids that make it possible to deliver an acceptable enhanced their skills and confidence to implement the quality of care by primary care physicians and non- WHO PEN protocol in practice. The project demon- physician health workers. Within the packages, evi- strated that the WHO PEN would be particularly dence-based interventions are structured as simple flow suitable for primary care physicians in China. charts with clear referral criteria in the clinical Based on this experience, the quality, equity, perfor- protocols. The cardiovascular disease risk prediction mance, and impact of implementation of WHO PEN tool enables health workers to target those who are at can be achieved with: (1) physician training and resident the highest risk for heart attacks, strokes, amputation, health education, (2) opportunistic screening at primary and kidney failure. The integrated multifactorial care settings for early identification of individuals with risk approach is more cost-effective and improves or at high risk for major NCDs, (3) registration of basic outcomes. demographic and clinical data when individuals present WHO PEN sets a minimum standard for the man- with NCDs in primary care, (4) evidence-based inter- agement of NCDs. Its implementation will increase the ventions, (5) monitoring of complications, (6) clear national capacity to integrate and improve primary care referral criteria and cooperative healthcare services, and interventions for heart disease, stroke, cardiovascular (7) increasing capacity for health system research and risk, diabetes, cancer, asthma, and chronic obstructive training. pulmonary disease in low-resource settings. Hyperten- The World Hypertension League recommends the sion and diabetes are the most common conditions that implementation of WHO PEN in low-resource settings substantially contribute to the burden of NCDs. There- as a cost-effective and equitable means to control fore, the implementation of WHO PEN should start hypertension in the context of other NCDs and health with the protocol for preventing heart attack, stroke, risks. People with NCDs require long-term care that is proactive, patient-centered, community-based, and sus- tainable. Such care can be delivered equitably only Address for correspondence: Xin-Hua Zhang, MD, Professor of through health systems based on primary healthcare. Medicine, Beijing Hypertension League Institute, Room 819, Block A2, The implementation of the WHO PEN interventions Bailangyuan, Fuxing Road A36 Haidian District, Beijing 100039, China will not only help to reduce the burden of NCDs and E-mail: [email protected] hypertension, but strengthen the efficiency and equity of Manuscript received: October 23, 2015; accepted: October 23, 2015 the health system. DOI: 10.1111/jch.12749 The Journal of Clinical Hypertension Vol 18 | No 1 | January 2016 5 WHO PEN | Zhang et al. 3. Package of Essential Noncommunicable (PEN). Disease interventions References for primary health care in low-resource settings. Geneva: World Health 1. Global status report on noncommunicable diseases 2014. Geneva: Organization;, 2010. http://apps.who.int/iris/bitstream/10665/44260/1/ World Health Organization; 2014. 9789241598996_eng.pdf. Accessed October 12, 2015. 2. Commission on social determinants of health. Closing gap in a 4. Implementing WHO PEN in community health care centers in China. generation: health equity through action on the social determinants of European Society of Cardiology Congress, London, UK, 2015. health. Final report. Geneva: World Health Organization; 2008. 6 The Journal of Clinical Hypertension Vol 18 | No 1 | January 2016 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Journal of Clinical Hypertension Wiley

Implementation of World Health Organization Package of Essential Noncommunicable Disease Interventions ( WHO PEN ) for Primary Health Care in Low‐Resource Settings: A Policy Statement From the World Hypertension League

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Wiley
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Copyright © 2016 Wiley Periodicals, Inc.
ISSN
1524-6175
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1751-7176
DOI
10.1111/jch.12749
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26646424
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Abstract

POLICY STATEMENT FROM THE WORLD HYPERTENSION LEAGUE Implementation of World Health Organization Package of Essential Noncommunicable Disease Interventions (WHO PEN) for Primary Health Care in Low-Resource Settings: A Policy Statement From the World Hypertension League 1 2 3 4 5 Xin H. Zhang, MD; Liu Lisheng, MD; Norm R.C. Campbell, MD; Mark L. Niebylski, MD, PhD; Peter Nilsson, DrPH; Daniel T. Lackland, PhD, MBA, MS; for the World Hypertension League From the Medicine, Beijing Hypertension League Institute, Haidian District, Beijing, China; Beijing Hypertension League Institute, Haidian District, Beijing, China; Departments of Medicine, Physiology and Pharmacology and Community Health Sciences, O’Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Clinical Cardiovascular Research, Lund University, Dept 4 5 Clinical Sciences, Skane University Hospital, Malmo, Sweden; Department of Neurosciences, Medical University of South Carolina, Charleston, SC; and World Hypertension League, Corvallis, MT Noncommunicable diseases (NCDs) accounted for more and kidney disease through integrated management of than two thirds of total deaths globally and 40% of hypertension and diabetes. Once primary healthcare NCD deaths in patients younger than 70 years. The workers develop the skills to effectively implement the majority (82%) of the premature deaths were from low- protocol, the portfolio can be expanded to other NCDs. and middle-income countries. Cost-effective interven- The feasibility of the protocol for management of tions for the prevention and management of NCDs are hypertension and diabetes has been tested in a commu- available. However, these interventions are often not nity-based prevention and control project that ran from accessible to the poor, especially in resource-constrained April 2013 to August 2014 in China. More than 2000 settings. Because of the lack of appropriate prevention primary care physicians from 200 community health- and care, many people are suffering unnecessarily from care centers in eight regions attended training sessions preventable NCDs and associated complications. based on the WHO PEN protocol. Preliminary analysis The World Health Organization developed the Pack- of data from the screening of 300,000 residents age of Essential Noncommunicable Disease Interven- indicated that the awareness, treatment, and control tions (PEN) for Primary Health Care in Low-Resource rate of hypertension improved continuously over the Settings, referred to herein as WHO PEN. It is a course of the project and the overall risk of cardiovas- prioritized set of cost-effective interventions, tools, and cular disease decreased. Concurrently, physicians aids that make it possible to deliver an acceptable enhanced their skills and confidence to implement the quality of care by primary care physicians and non- WHO PEN protocol in practice. The project demon- physician health workers. Within the packages, evi- strated that the WHO PEN would be particularly dence-based interventions are structured as simple flow suitable for primary care physicians in China. charts with clear referral criteria in the clinical Based on this experience, the quality, equity, perfor- protocols. The cardiovascular disease risk prediction mance, and impact of implementation of WHO PEN tool enables health workers to target those who are at can be achieved with: (1) physician training and resident the highest risk for heart attacks, strokes, amputation, health education, (2) opportunistic screening at primary and kidney failure. The integrated multifactorial care settings for early identification of individuals with risk approach is more cost-effective and improves or at high risk for major NCDs, (3) registration of basic outcomes. demographic and clinical data when individuals present WHO PEN sets a minimum standard for the man- with NCDs in primary care, (4) evidence-based inter- agement of NCDs. Its implementation will increase the ventions, (5) monitoring of complications, (6) clear national capacity to integrate and improve primary care referral criteria and cooperative healthcare services, and interventions for heart disease, stroke, cardiovascular (7) increasing capacity for health system research and risk, diabetes, cancer, asthma, and chronic obstructive training. pulmonary disease in low-resource settings. Hyperten- The World Hypertension League recommends the sion and diabetes are the most common conditions that implementation of WHO PEN in low-resource settings substantially contribute to the burden of NCDs. There- as a cost-effective and equitable means to control fore, the implementation of WHO PEN should start hypertension in the context of other NCDs and health with the protocol for preventing heart attack, stroke, risks. People with NCDs require long-term care that is proactive, patient-centered, community-based, and sus- tainable. Such care can be delivered equitably only Address for correspondence: Xin-Hua Zhang, MD, Professor of through health systems based on primary healthcare. Medicine, Beijing Hypertension League Institute, Room 819, Block A2, The implementation of the WHO PEN interventions Bailangyuan, Fuxing Road A36 Haidian District, Beijing 100039, China will not only help to reduce the burden of NCDs and E-mail: [email protected] hypertension, but strengthen the efficiency and equity of Manuscript received: October 23, 2015; accepted: October 23, 2015 the health system. DOI: 10.1111/jch.12749 The Journal of Clinical Hypertension Vol 18 | No 1 | January 2016 5 WHO PEN | Zhang et al. 3. Package of Essential Noncommunicable (PEN). Disease interventions References for primary health care in low-resource settings. Geneva: World Health 1. Global status report on noncommunicable diseases 2014. Geneva: Organization;, 2010. http://apps.who.int/iris/bitstream/10665/44260/1/ World Health Organization; 2014. 9789241598996_eng.pdf. Accessed October 12, 2015. 2. Commission on social determinants of health. Closing gap in a 4. Implementing WHO PEN in community health care centers in China. generation: health equity through action on the social determinants of European Society of Cardiology Congress, London, UK, 2015. health. Final report. Geneva: World Health Organization; 2008. 6 The Journal of Clinical Hypertension Vol 18 | No 1 | January 2016

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Published: Jan 1, 2016

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