Strategic Health Care Network against CKD in Mexico (CKDSN) Federal - PowerPoint PPT Presentation

Strategic Health Care Network against CKD in Mexico (CKDSN) Federal Health Secretariat Innovation and Quality Subsecretariat Mexican Government 2010 Presented by: Librado de la Torre-Campos, MD Guillermo Garcia-Garcia, MD

Background • Mexico has one of the highest prevalence of DM in the world. • The prevalence of CNCDs, like DM, HTN, overweight has increased significantly in Mexico (Fig 1) • It is estimated that 70% of CKD cases in persons >20 years is associated to one or two CNCDs.

Fig. 1. CNCDs Prevalence in Mexico 1993 (%) 2000 (%) 2006 (%) Diabetes Mellitus ≥ 20 y 7.20 10.7 9.50 20-34 y 23.2 29.3 35-54 y 51.5 46.7 55-69 y 25.3 24.0 Hypertension ≥ 20 y 26.6 30.5 26.5 20-34 y 29.3 23.2 35-54 y 46.7 51.5 55-69 y 24.0 25.3 Overweight and Obesity ≥ 20 y 59.4 63.5 69.5 20-34 y 34.9 35-54 y 49.0 55-69 y 16.2

Background • 12% of DM cases and 7% of HTN cases develop CKD. When the two co-exist, the risk increases to 40%. • According to the National Health Survey and Nutrition 2006, 68% of hypertensive individuals and ##% of diabetics were not aware of their illness. • 7% of the Mexican population is reported to have CKD, and many are not aware of it. 96% of these patients have CKD stage 1-3 and 300,000 individuals have CKD stage 4-5 (Fig. 2)

Fig.2. Burden of Disease CKD prevalence by age group 1% 16% 45-64 20-44 45% 65-74 19% ≥75 0-19 19%

Background • In conclusion, public health policy in Mexico has failed to promote health and prevention and detection of CNCDs.

Background • Due to the lack of planning and coordination, CKD treatment has focused on costly RRT, neglecting early detection and treatment of early stages of CKD. (Fig 3) • Additionally, access to RRT is universal to individuals with social security but severly restricted to those without insurance. • Only 22% of the Mexican ESRD population has access to RRT at a cost of $ 580.00 US million dollars a year.

Background • It has been estimated that universal access to RRT in Mexico will cost $ 3.0 US billion dollars, representing 40% of the national health budget. • Fig. 3 describes the estimated cost of ESRD treatment in 5 different scenarios: a) partial (22%) vs universal (100%) coverage; b) current RRT vs alternative RRT distribution; c) 2009 vs 2025.

Fig. 3 CKD treatment. Current expenses. ANNUAL ANNUAL COST, COST$ ANNUAL COST $ ^ RRT % Distribution CKD CKD STAGE 1-3 CKD STAGE 4-5 TREATMENT PD---HD---KT PREVENTION TREATMENT 22 % $ 581 80 ---- 19.8 ---- 0.2 2009 100 % $ 2,538 $ 0.0 22% $618 100 % $ 2,812 2025* 100 % $ 3,833 20 ---- 79.8 ---- 0.2 100 % $ 3,336 16- ---- 64 ---- 20 ^millions of US dollars *50% estimated reduction of patients reaching ESRD

CKDSN: Target population • General population • High-risk population with CNCDs • CKD population

CKDSN: Mission • To promote renal health and prevention of CKD through early detection and treatment, under the supervision of a kidney specialist, and with strictly adherence to clinical guidelines. • To provide informed patient care with a minimum of complications, improving patient’s quality of life and social rehabilitation, with optimization of the National Health System’s resources.

CKDSN: Vision • To become an efficient and effective national health care network for the promotion of renal health, through early detection and treatment of CKD, and to achieve a 50% reduction of all CKD stages’ prevalence by the year 2025.

CKDSN: Objectives (Fig. 4) • Promotion of Renal Health in the community • CKD early detection and treatment to retard progression or reversion of kidney disease • Decrease mortality

Fig. 4 Network’s goals CKD Stage 0 1 2 3 4 5

Promotion of Renal Health: Objectives • The community will become familar with normal kidney function • The community will identify risk factors for CKD • The community will identify the health clinics as the place to detect and treat CKD.

Promotion of Renal Health: Lines of action • Permanent education community programs on CKD prevention and treatment. • Equipment and upgrading of existing infrastructure of health clinics • CKD on-line education programs for health professionals (general practitioners, nurses, nutritionists, medical students) • Periodic evaluation of clinical competences

Promotion of Renal Health: Action Lines • Accreditation of health clinics by the SI Calidad* program • Organizing Renal Health Committees in each health clinic • Certification of the health clinic by the General Health Council • Fig. 5 describes the action lines and expected outcomes of health promotion and education *Integral Health Quality System

Fig. 5 RENAL HEALTH PROMOTION STRATEGIC PLAN EQUIPMENT CKD AND CNCDs AND/OR CONTINUOS CKD and CNCDs HEALTH UPGRADING THE QUALITY COMMUNITY PROFESSIONAL NETWORK’S IMPROVEMENT EDUCATION TRAINING CLINICS STRATEGIES INFRASTRUCTURE EXPECTED OUTCOMES EFFECTIVE TIMELY COMMUNICATION HEALTHY LIFE RISK LOWER CKD BETWEEN HEALTH DETECTION AND CONTAINMENT STYLE INCIDENCE PERSONNEL AND TREATMENT THE COMMUNITY

CKD Prevention and Treatment: Objectives • CNCDs treatment compliance • Enforcement of treatment goals • Early detection of kidney disease • Timely CKD treatment to delay or prevent progression of kidney disease • Periodic monitoring of kidney function

CKD Prevention and Treatment: Strategies • Development of clinical guidelines • Care coordination of CKD patients with existing CNCDs (DM, hypertension, and obesity) programs • Inclusion of CKD stages 1-3 screening tests and treatment, in the catalog of the Popular Health Insurance (Seguro Popular). • Development of an internet platform network • Fig. 6 describes the strategies and expected outcomes of CKD prevention and treatment.

Fig. 6 CKD PREVENTION AND TREATMENT ACTION PLAN TIMELY AVAILABLITY ACCESS TO THE REGISTRY OF CKD DEVELOPMENT OF OF DRUGS FOR ELECTRONIC PATIENTS IN THE CKD CLINICAL TREATMENT OF DATABASE IN EACH ELECTRONIC DATA GUIDELINES CNCDs and CKD CLINIC BASE STAGE 1-3 EXPECTED OUTCOMES TREATMENT UPTADATED AND EFFECTIVE PROVIDED BY CKD REGRESION RELIABLE DATA PATIENT COMMUNICATIO GPs WITH OR DELAY IN CKD BASE FOR SATISFACTION N BETWEEN NEPHROLOGIST PROGRESSION REASEARCH AND WITH DELIVERY NETWORK AND DECISION OF CARE PARTICIPANTS NUTRITIONIST MAKING SUPERVISION

Lowering ESRD mortality: Objectives • CKD treatment to delay or prevent progression of renal function • Timely nephrology referral • Improving the quality of dialysis and kidney transplantation centers • Implementation of third-party, dialysis and kidney transplantation programs • Fig. 7 describes the strategies and expected outcomes to decrease ESRD mortality.

Fig. 7 LOWERING ESRD MORTALITY ACTION PLAN STRENGHTING THE QUALITY ACREDITATION PROMOTE ORGAN INCREASE THE REGULATIONS FOR IMPROVEMENT IN AND DONATION AND NUMBER OF PD AND HD PD AND HD KIDNEY CERTIFICATION OF NEPHROLOGISTS TRANSPLANTATION CLINICS PERSONNEL RRT CENTERS OPERATION EXPECTED OUTCOMES DECREASE CKD COMPETETIVE INCREASE QALYs DECREASE PATIENT COMPLICATIONS PRICE OFFERED BY AND DECREASE MORTALITY AND THE HIGH DALYs OF CKD ASSOCIATED TO PRIVATE HD AND COST OF RRT PATIENTS ESRD PD UNITS

Parties involved: Responsabilities • National Center of Technological Excellence in Health : Development of clinical guidelines • National Center of Disease Control and Epidemiology Surveillance: Coordination of existing Specific Programs for Diabetes Mellitus and Hypertension with the CKD Stratetegic Network • Popular Health Insurance: Inclusion of screening tests and treatment of CKD in its disease catalog.

Parties involved: Responsabilities • Health Risks Federal Commission (COFEPRIS): visual identification on labels of nephrotoxic drugs • National Health Council : Certification of primary care clinics and dialysis and kidney transplantation centers. • Quality and Health Education General Office : coordinate the education and training of health professionals in the prevention and treatment of CNCDs and CKD; promote the inclusion of CNCDs and CKD prevention and control in medical school curriculum • Performance Evaluation Office : evaluation of the program outcomes

Parties involved: Responsabilities • Health Informatics Office : development of the internet network platform and digital database • Health Planning and Development Office : organization of the strategic network; establishing inclusion criteria for participating health clinics; strategies for delivery of drug and tests supplies to participating clinics. • Health Promotion Office : health promotion and education in the community. Objectives:1) recognition of CKD risk factors ; 2) identification of the primary care clinic as the place for the treatment and detection of CNCDs and CKD; and 3) Impact of CKD in the individual and the community.