Leonard G. Christie, MD MPH, Oregon Cardiovascular Teachings, Ltd, 771 W 52nd Ave, Eugene, OR 97405, 541-912-8110, firstname.lastname@example.org and James D. Fett, MD MPH, Hopital Albert Schweitzer, 611 Sumner Ave, Aberdeen, WA 98520.
“On the ground” in developing countries medical treatment is focused on incidents of care such as injury or an infection that are “curable”. However, just as in the United States, developing environments are increasingly faced with chronic illness. Heart failure (HF) is a chronic disease causing disability and consuming increasing resources worldwide, not just in rich countries. Heart failure is a prominent cause of death and disability in rural Haiti, where our studies have documented the highest incidence of pregnancy related heart failure in the world. To provide equitable, systematic, and consistent care a population approach to management has been developed at one rural hospital in Haiti. Using a disease registry patient status is compared, clinical course tracked, and treatment organized. Embedded in the registry are heart failure guidelines reminders and an automated notice of guideline compliance. From the registry, patient population data facilitates (a) planned follow up of patient subgroups receiving sub-optimal treatment (b) guideline compliance, and (c) systematic follow up. Observations: 94% receive ACE inhibitors, 20% receive HF beta blockers, 68% have improved NYHA class during follow (2.4 years), 15% of atrial fibrillation patients receive warfarin. CONCLUSIONS: (1) Being a developing world environment does not prevent application of chronic disease management techniques. (2) Use of a disease registry in such an environment, employing low cost technology, facilitates population based care and the patients right to modern standards of care. (3) These tools should apply to management of other chronic diseases (e.g. HIV/AIDS) for both the rich and poor.
Keywords: Chronic Illness, Disease Management
Presenting author's disclosure statement:
The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA