Chronic diseases and health promotion

Part Four - Taking action: essential steps for success

Chapter One: Providing a unifying framework - the role of government

Emphasize prevention and management

As reviewed in Part Three, disease onset can be prevented through the identification and reduction of elevated risk, and complications of established disease can also be addressed using prevention strategies. Risk prediction derived from multiple risk factors is more accurate than making treatment decisions on the basis of single risk factors. In most cases, a combination of interventions is required to realize the full potential of risk reduction. Access to essential drugs should be a key component of the policy framework, focusing on rational selection, affordable prices and sustainable financing. For effective implementation of these drug policies, supply management systems need to be integrated into health system organization.

Implementation step and suggested milestones

STEP 1 CORE: Tobacco use is routinely assessed and tobacco cessation services are provided. Affordable first-line chronic disease medications such as aspirin and beta blockers, as well as blood pressure and cholesterol lowering drugs, are made available in primary health care.

STEP 2 EXPANDED: Patients’ levels of overall risk are systematically assessed and monitored during health care visits. Treatment interventions are based on locally tailored guidelines and based on overall risk, rather than arbitrary cut-off levels of individual risk factors. Second-line and third-line medications for chronic disease are made available and affordable.

STEP 3 DESIRABLE: Comprehensive prevention programmes are available in primary health care.

Establish effective clinical information systems

Clinical information systems assist in coordinating the overall operation of the health-care centre, organizing patient information, tracking and planning patient care and facilitating patient self-monitoring, as well as prompting health-care providers to schedule patient follow-up. Effective systems can be created regardless of resource level; they range from computerized registries to pencil-and-paper schemes, and they can be written or pictorial.

Implementation step and suggested milestones

STEP 1 CORE: Basic paper-based patient registries and medical records for patients with chronic disease are introduced into primary health care.

STEP 2 EXPANDED: Computer-based patient registries and medical records for chronic disease patients are introduced into primary health care. Patient information is shared between primary health care and specialty/hospital care.

STEP 3 DESIRABLE: All health care settings are electronically linked via a common clinical information system.