|
 Home Minister & Policy
Minister & Policy
 Chung-Hua County Community Metal Health Promotion Strategies for 2006
●Forward (overview and problem analysis)
- Our current disease prevention policies are mainly focus on national-wide cervical cancer screening; however, only 40% of women age 30 and above have a Pap smear. In terms of chronic diseases, since the establishment of national health insurance services in 1995, the government encourage adult annual checkup (focus on diabetes, high blood pressure and high blood lipid (hyperlipidemia) three chronic diseases). Up to date, the screening rate for those diseases remains below 30% and repeated screening rate is quite high. Besides, there is no integrated referral and monitoring system, hence, it is difficult to assess the efficiency of the policies. Data from National Health Insurance provide information regarding how and where diabetic patients seek health cares within our county. After our Health Bureau promotes local health clinics to provide “package payment” medical cares for diabetic patients, now patients can receive complete cares within short distance from home.
- To establish an effective community disease screening service, we emphasize on the integration of resources, screenings, and services. We actively utilize community preventive services to early detect diseases and provide needed referral services. This community-based integrated screening service also provides a bridge to help promoting preventive services within communities.
- Chung-Hua County has established cancer screenings since 2002. The screening was first initialized in townships that have larger cancer mortality, and the screening was welcomed by the community residents. However, there are some pitfalls that need to be addressed, such as the lack of standardized referral procedures, unable to effectively finalize an unusual case, and lack of systematic design of screening services.
- Out urgent need is how to integrate community man power and health care providers, including the organization of health clinics and medical centers man power, the participation of community screening systems, the collaboration of disease care and referral services, the structure of disease management concept, the establishment of community health management, in order to satisfy the integrated preventive services among community residents, health care and the public health.
●Goals
- We plan to organize 30 screening activities, target total of 10000 residents within 26 townships and 27 health clinics in 2006.
- Each screening activity would include more than 300 participants, and among all the participants, 100 participants would be women, age 30 and above and have not had Pap smear for more than 3 years.
●Main organization and collaborated organization
- Main organization: Health Bureau of Chung-Hua County
- Collaborated organizations:
- Experts from public and private research academics
- Local health clinics and area hospitals within Chung-Hua County
- Health Bureau of Chung-Hua County and its township health clinics
●Analysis of target population
- Demographic
2005 demographic data showed that there were 632477 male (52.6%), 570434 female (47.4%) in Chung-Hua County. Among them, 533508 (44.4%) were age 30 and below, 167893 (14.0%) were age 30-39, 179588 (14.9%) were age 40-49, 134354 (11.2%) were age 50-59, 91373 (7.6%) were age 60-69, 69462 (5.8%) were age 70-79, and 26733 (2.2%) were age 80 and above. The demographic among all the townships in Chung-Hua county showed as following: in every township, male were about 52%-54%, and female were about 44%-47%; the trend was male population was more than female population.
- Age and gender of the target screening population
We would target the following groups for our community screenings: male age 40 and above and participate adult annual physical checkup, same criteria for female and plus those women, age 30-39 who has not have a Pap smear in the past three years.
●Epidemiology of screening field
According to 2004 August demographic statistic, total population in Chung-Hua County is around 1310000 people, and population age 40 and above are 510000, which consist of 38.93% of the total population. Among the 509016 people age 40 and above in the county, we estimate 50902 are diabetes patients based on 10.0% disease prevalence. Data provided by the Bureau of Health Insurance shows how and where the diabetes patients seek treatments (53% in medical centers, 34% in area hospitals, 7% in private or local clinics). The data indicates majority package payment medical facilities are major hospitals; very low percentage of local health clinic facilities.
●Human resource and organization structures
- Human resources: community health care providers, township health clinic workers, public health volunteers.
- Structures:
The front line operating group is the primary working agency; each township health clinic is in charge of preparation prior to the operations and referral services afterward. In terms of communication aspect, planning division is responsible of questionnaire data entry and test results input; for questionnaire organization, the policy section agency will provide space for easy access. Disease control division is responsible for TB screenings, which includes arrangement of mobile X-ray facility, X-ray slides diagnosis, notification of positive cases, and referral services. Examination division is responsible for biological sample analysis and its quality control, and sample waste management. For chronic diseases, which include three high priority chronic diseases and cancer, workers are responsible for case monitoring and referral, and case build up and data entry.
- Visual inspection of human resource on site: doctors, nurses, and volunteers.
- Evaluation of community screening services
- Involvement of various community members
- Referral services and quality assurance
●Screen items and execute method
●Information system
- System management
- xternal data input: provide external information inputs such as residency, breast cancer data, ?? screenings data and medical treatments information.
- Access management: security setting for different level of users
- Appointment system
Easy assess to appointment system for people who undergo screening, and provide on-line out?? patient information for various medical facilities.
- Questionnaire data system
?Questionnaire would record life style and dietary habit of the patients, disease history, family history of cancer and chronic diseases, female breast feeding history, and screening services satisfaction.
- Test result input system
- Blood work results automatic entry procedures
- Fecal blood index automatic entry procedures
- Referral surveillance system
The system should manage cases based on their diseases, including treatment progresses after referral service. Besides, the system should include referral surveillance works conducted by health clinic workers. The referral surveillance procedures include print out of referral statements, notification result inputs, referral result inputs.
- Results output and search system
The system should provide screening results for patients
- Data analysis system
The system would provide statistic of referral surveillance information and so on
- Relate resources search
The system would provide health providers information regarding the progress of screening or surveillance of cases, and search of those cases that lost in referral or surveillance procedures. By implementing the system, it will improve the efficiency and reduce the man power and support after screening process.
●Referral management
The following are the lay out of referral procedures for various chronic diseases and cancer that outline in this strategy plan:
- High blood pressure cases
The screening for high blood pressure is based on having systolic pressure >= 140mmHg, or diastolic pressure >=90mmHg. New cases will be referred to hospitals for detailed examinations and treatments. For old cases, a further interview regarding treatment such as medication use, self monitoring and dietary control will be conducted.
- Diabetes cases
The results from diabetic screening would detect new cases, old cases, and suspect cases, that have no disease history and blood sugar level prior to meal is 110-125mg/dL. All diabetic patients would participate in “Diabetic Care Networks”. Those suspect cases will undergo follow up and verification by medical center using OGTT test within one month interval in order to verify their diabetic status. For those cases that undergo medical treatments regularly, we would encourage their follow up and treatments. For those cases that did not seek medical treatments, they would be in the list for individual health education and surveillance by local department of health. For diabetic care, we encourage the collaboration among medical centers to provide the best resources for the following care such as vision care, kidney function, and neurological care, cardiovascular and pediatric cares.
- High blood lipid
There are three indicators for high blood lipid, including cholesterol level greater than 240mg/dL, or high density protein below 35mg/dL, or low density protein above 100. As long as one of the aforementioned criteria is met, the patient is categorized as high blood lipid case, and he/she can be a new case or an old case. If a newly diagnosed case has somewhat high level of biological marker, we would provide health education and monitor the case for the following three months. If a case has an unusual high level of the marker, he/she would be referred to a specialist flow detailed examination. If there is a family history of high blood lipid, we would recommend other family members to participate in screenings. To avoid complication due to the condition, a patient should make dietary adjustment, life style change, medication use, and follow doctor's orders. For old cases, we would follow up with their prognosis, and provide health education to maximize the effectiveness of treatments.
- Cervical cancer screenings—Pap test screenings
The proposed screening policy is similar to the Pap test screening policy. We expect that more women would participate in screenings due to the integrated screening services, and as a result, increase the Pap test screening rate. The screening should be done every three years. We would work with other medical and laboratory facilities in our county and link with nation wide Pap test management system to identify those residents that have not had the test more than 3 years within our county townships. Once identified, the health clinics would mail, phone, and notify to invite them for community integrated screenings. If a positive case is detected, she would have a detailed examination and treatment in specialized medical centers. If cancerous cells changes are suspect, a further biopsy will be needed.
- Breast cancer screenings
Our initial integrated screening procedures involve collection of menstrual and child bearing history in order to determine its risk scores; a case is considered high risk if the score exceed 50%. Some risk factors include the age of first menstruation, number of pregnancies, oral contraceptive use, breast feeding, age of menopause, and family history of breast cancer and etc. The second stage screening involves mammogram, once abnormal is detected, detailed examination such as ultrasound and tissue samples would be performed. In addition, due to high genetic aspect of breast cancer, we would focus on screening immediate family line of the patient. We would encourage immediate family members to have mammogram every year to lower the incident rate of late stage breast cancer.
- Colon cancer screenings
Abnormal patient would be referred to a specialist for Colonoscopy, Flexible Sigmoldoscopy or Double-Contrast Barium Enema.
- Liver cancer screenings
Positive cases would undergo abdominal ultrasound, and if the ultrasound shows possible abnormality, the patient would be referred to a specialist for liver cancer diagnosis. If the ultrasound result is normal, we recommend the patient having bio-marker and ultrasound examination annually. For the cirrhosis patients, the follow up examination should be done every 3-6 month.
●Quality assurance
- Control of examination quality
- Control of budget
- Control of plan progress
●Resource integration
- Human resource integration: collaboration among community volunteers, local clinics providers and Bureau Health man power
- Budget integration: integrate health insurance and preventive health resources
- This integrated preventive screening plan is the major step of integrating workloads within the Bureau Health various divisions. We would provide the residents convenient preventive health services, which combine screenings and health education, in order to help them to understand their health status.
●Plan evaluatio
- Screening participants: expect 100%
- Each screening would recruit more than 300 people, and among them there would be at least 100 women, age 30 and above, who have not had a Pap test in the last 3 years.
- Provide complete referral services; refer at least 70% of abnormal colon cancer cases, and at least 90% for other type of cancers.
- For quality control: require manufacturers to be certified in 2006.
|
