Menon Jaideep, Numpeli Mathews, Kunjan Sajeev P, Karimbuvayilil Beena V, Sreedevi Aswathy, Panniyamakkal Jeemon, Suseela Rakesh P, Thachathodiyil Rajesh, Banerjee Amitava
Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India.
National Health Mission, Kochi, India.
JMIR Res Protoc. 2021 Oct 22;10(10):e27299. doi: 10.2196/27299.
India has a massive noncommunicable disease (NCD) burden, at an enormous cost to the individual, family, society, and health system at large, despite which prevention and surveillance are relatively neglected. If diagnosed early and treated adequately, risk factors for atherosclerotic cardiovascular disease would help decrease the mortality and morbidity burden. Surveillance for NCDs, creating awareness, positive lifestyle changes, and treatment are the proven measures known to prevent the progression of the disease. India is in a stage of rapid epidemiological transition, with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country in the future. A previous study done by the same investigators in a population of >100,000 revealed poor awareness, treatment of NCDs, and poor adherence to medicines in individuals with CVD.
This study aimed at assessing a sustainable, community-based surveillance model for NCDs with corporate support fully embedded in the public health system.
Frontline health workers will check all individuals in the target group (≥age 30 years) with further follow-up and treatment planned in a "spoke and hub" model using the public health system of primary health centers as spokes to the hubs of taluk or district hospitals. All data entry done by frontline health workers will be on a tablet PC, ensuring rapid acquisition and transfer of participant health details to primary health centers for further follow-up and treatment.
The model will be evaluated based on the utilization rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centers for risk stratification and care, and community-level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow-up treatment at no cost to the individual entirely through the tiered public health system of the state and country.
Surveillance for NCDs is an essential facet of health care presently lacking in India. Atherosclerotic cardiovascular disease has a long gestation period in progression to the symptomatic phase of the disease, during which timely preventive and lifestyle measures would help prevent disease progression if implemented. Unfortunately, several asymptomatic individuals have never tested their plasma glucose, serum lipid levels, or blood pressure and are unaware of their disease status. Our model, implemented through the public health system using frontline health workers, would ensure individuals aged≥30 years at risk of disease are identified, and necessary lifestyle modifications and treatments are given. In addition, the surveillance at the community level would help create a general awareness of NCDs and lead to healthier lifestyle habits.
Clinical Trial Registry India CTRI/2018/07/014856; https://tinyurl.com/4saydnxf.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/27299.
印度面临着巨大的非传染性疾病（NCD）负担，给个人、家庭、社会和整个卫生系统带来了巨大成本，尽管如此，预防和监测却相对被忽视。如果能早期诊断并得到充分治疗，动脉粥样硬化性心血管疾病的危险因素将有助于减轻死亡率和发病率负担。对非传染性疾病的监测、提高认识、积极改变生活方式以及治疗是已知的可预防疾病进展的有效措施。印度正处于快速的流行病学转变阶段，喀拉拉邦处于前沿，这让我们看到了该国其他地区未来可能面临的疾病负担和结果。同一研究人员此前在超过10万人的人群中进行的一项研究显示，心血管疾病患者对非传染性疾病的认识、治疗情况以及药物依从性较差。
本研究旨在评估一种可持续的、基于社区的非传染性疾病监测模式，该模式在企业支持下完全融入公共卫生系统。
一线卫生工作者将对目标群体（年龄≥30岁）中的所有人进行检查，并按照“轮辐 - 轮毂”模式进行进一步随访和治疗，以初级卫生中心的公共卫生系统作为轮辐，以县或区医院作为轮毂。一线卫生工作者进行的所有数据录入都将在平板电脑上完成，确保快速获取参与者的健康细节并将其传输到初级卫生中心进行进一步随访和治疗。
该模式将根据各级提供的各种服务的利用率进行评估。年度调查中筛查的目标人群比例、到达轮辐或轮毂中心进行风险分层和护理的符合条件个体比例以及社区层面的高血压和糖尿病控制情况将用作指标变量。该模式通过国家和地区的分级公共卫生系统确保个人无需付费即可进行诊断和后续治疗。
非传染性疾病监测是印度目前医疗保健中缺失的一个重要方面。动脉粥样硬化性心血管疾病发展到症状期有很长的潜伏期，在此期间，如果实施及时的预防和生活方式措施，将有助于预防疾病进展。不幸的是，许多无症状个体从未检测过血糖、血脂水平或血压，也不知道自己的疾病状况。我们通过公共卫生系统利用一线卫生工作者实施的模式将确保识别出年龄≥30岁的疾病风险个体，并给予必要的生活方式调整和治疗。此外，社区层面的监测将有助于提高对非传染性疾病的普遍认识，并养成更健康的生活习惯。
印度临床试验注册中心CTRI/2018/07/014856；https://tinyurl.com/4saydnxf。
国际注册报告识别码（IRRID）：DERR1-10.2196/27299。
