Hyon Choe Suk, Nam Kim Yong, Sun Han Chae, Garg Renu, Shrestha Suraj Man, Ok Kim Un, Kumar Rajesh
Ministry of Public Health, Pyongyang, Democratic People's Republic of Korea.
World Health Organization Regional Office for South-East Asia, New Delhi, India.
WHO South East Asia J Public Health. 2017 Sep;6(2):69-73. doi: 10.4103/2224-3151.213794.
The prevention and control of noncommunicable diseases (NCDs) is a priority for the Democratic People's Republic of Korea. Mortality due to NCDs in people aged over 30 years was 1239 per 100 000 in 2009 and the 2014-2020 national strategy includes population-level goals for health promotion and disease prevention. This paper reports a pilot study on the feasibility of implementing components of the World Health Organization (WHO) Package of essential noncommunicable disease (PEN) interventions for primary health care in low-resource settings (WHO PEN) to enable early detection and management of cardiovascular disease and diabetes mellitus at the level of primary care. WHO PEN protocols were adapted for local use by household doctors, who provide ambulatory care in polyclinics in the mornings and household visits in the afternoons. The pilot project was implemented in two polyclinics in Pyongyang, covering a population of 32 000. After training, and during routine household visits in June 2014, 70 household doctors screened all adults aged over 35 years (18 340) for cardiovascular disease and diabetes mellitus, and their risk factors. A total of 2319 patients with cardiovascular disease or diabetes, and those with high-risk factors, were referred to the polyclinics for three quarterly visits for testing and management. Final household screening of the population was done in June 2015. This pilot project demonstrated the feasibility of integrating screening and management into the standard primary health-care system in the Democratic People's Republic of Korea. The household doctors were able to detect and manage risks for cardiovascular disease and diabetes by using the protocols based on WHO PEN. Among 18 340 individuals aged over 35 years, implementation of WHO PEN interventions led to a significant reduction in the number of people with a 10-year risk of cardiovascular disease ≥20% (from 1748 [9.5%] to 543 [3.0%]) over a 1-year period. Involvement of household doctors can increase access to services for prevention and control of cardiovascular disease and diabetes in the Democratic People's Republic of Korea.
非传染性疾病（NCDs）的预防和控制是朝鲜的一项优先工作。2009年，30岁以上人群中因非传染性疾病导致的死亡率为每10万人1239例，2014 - 2020年国家战略包括促进健康和疾病预防的人群层面目标。本文报告了一项试点研究，该研究针对在资源匮乏地区的初级卫生保健中实施世界卫生组织（WHO）基本非传染性疾病综合干预措施（WHO PEN）组成部分的可行性，以在初级保健层面实现心血管疾病和糖尿病的早期检测与管理。WHO PEN方案经家庭医生调整后供当地使用，这些家庭医生上午在综合诊所提供门诊护理，下午进行家访。该试点项目在平壤的两家综合诊所实施，覆盖人口32000人。经过培训后，在2014年6月的常规家访期间，70名家庭医生对所有35岁以上成年人（18340人）进行了心血管疾病、糖尿病及其危险因素的筛查。共有2319例患有心血管疾病或糖尿病以及有高危因素的患者被转介到综合诊所进行三个季度的检查和管理。2015年6月对该人群进行了最终的家庭筛查。该试点项目证明了在朝鲜将筛查和管理纳入标准初级卫生保健系统的可行性。家庭医生能够通过使用基于WHO PEN的方案检测和管理心血管疾病和糖尿病风险。在18340名35岁以上个体中，实施WHO PEN干预措施在1年时间内使心血管疾病10年风险≥20%的人数显著减少（从1748人[9.5%]降至543人[3.0%]）。家庭医生的参与可以增加朝鲜民众获得心血管疾病和糖尿病预防与控制服务的机会。
