Telehealth for NCD in Thailand: Lesson learn from THAI-HBPM

Somkiat Sangwatanaroj, MD.

Division of Cardiovascular Medicine,

Faculty of Medicine, Chulalongkorn University.

King Chulalongkorn Memorial Hospital, Thai Red Cross Society

Bangkok, Thailand 10330

Hypertension & Mental Health Mei-Yan Liu. Neuro Res 2017; 39: 573-580 Association between Depression/Job strain and HT

Association between HT and Mental stress

Hypertension program in Thailand: Screening and diagnosis of hypertension

Somkiat Sangwatanaroj, MD.

Division of Cardiovascular Medicine,

Faculty of Medicine, Chulalongkorn University.

King Chulalongkorn Memorial Hospital, Thai Red Cross Society

Bangkok, Thailand 10330

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• Lower awareness & treated of HT. than controlled in Thailand.

• Screening and diagnosis of HT in Thailand:

– With daytime ABPM and/or HBPM

– Why Telehealth ?

Hypertension in Asia: HOPE Asia network. J Clin Hypertens 2017 Aug 17. doi:

10.1111/jch.13058.

(45.8♂,64.8♀) (56.6♂,62.8♀)

(2015)

(2017)

(2014)

(2013)

(2014)

(2013)

(2015)

(2016) (2013) (2016)

(25.6♂,23.9♀) (39.3♂,59.2♀)

2557 (2014)

50 M. Thai adults screening

37.65 M. Normotension +

Never Dx HT

12.35 M. High BP +

Dx HT

5.52 M. UnDx High BP

(♂3.4 M.+♀2.1 M.)

? M. White Coat HT ? M. Missed to Dx HT

0.75 M. Dx UnRx

6.08 M. RxHT

3.67 M. Controlled

? ME ? CH

2.41 M. Uncontrolled

? WE ? SH

HT in Thailand 2014: burdens &

problems (Adapted from NHES 5)

Know your numbers (anyone, anywhere, anytime)

Because you can’t change what you don’t know

Screening & Diagnosis of HT:

with

Ambulatory Home Blood Pressure Monitoring(ABPM)

or Home Blood Pressure Monitoring(HBPM)

Lessons from International Guidelines

Hypertension guidelines • JNC7 2003 (Seventh report of Joint National Committee on prevention, detection, evaluation & treatment of high BP) JAMA May 2003; 2560-72

• WHO/ISH statement on Mx. of HT J HT 2003; 21: 1983-1992

Japan Society of Hypertension guidelines for HBPM 2003

• Canadian recommendation Mx HT Can J Cardiol Jan 2004; 20: 55-9

• British HT Society HT Mx (BHS-IV) BMJ Mar 2004: 328: 634-40

• ESC HT guidelines 2007 Eur Heart J 2007;28:1462-1536

BHS NICE guidelines Aug 2011 www.nice.org.uk/CG127

• ESH/ESC guidelines of arterial HT 2013 (735 ref., 72 pages)

• JNC8 2014 JAMA Dec 2013

Japan Society of Hypertension 2014

U.S. Preventive Service TF recommendation: Screening HT 2015

Canadian Hypertension Education Program 2015 (Canadian J Cardiol 2015;31: 549)

Taiwan Hypertension Society 2015

The Royal Australian College of General Practitioners 2016

Hypertension Canada’s 2017 Guidelines

AHA/AHA/..US 2017 High BP Clinical Practice Guideline (13 Nov 2017)

= Ambulatory+Home Blood Pressure Monitoring (ABPM+HBPM) recommended

Thai guidelines for Rx of HT 2015

Thai >35 yr. No previous

Dx. of HT & No anti-HT Med.

+ Screening BP >140/90 mmHg Clinic BP

Normotension & Pre-HT D2 High CBP

Severe CBP Dx by CBP/OBP

Newly Dx HT by ABPM/HBPM

NT <120/80

C1. Pre-HT with ABPM/HBPM

D1 Pre-HT C2. High CBP with

ABPM/HBPM

D3 Severe CBP

C3 Severe CBP with ABPM/HBPM

(NICE 2011)

Daytime Ambulatory Blood Pressure Monitoring Home Blood Pressure Monitoring

in

/American Academy of Physician Assistants/Association of Black Cardiologists/ American College of Preventive Medicine/American

Society of Hypertension/ American Geriatrics Society/American Pharmacists Association/

American Society for Preventive Cardiology/National Medical Association/ Preventive Cardiovascular Nurses Association.

(by using HBPM+ABPM)

Telehealth in

/American Academy of Physician Assistants/Association of Black Cardiologists/ American College of Preventive Medicine/American Society of Hypertension/

American Geriatrics Society/American Pharmacists Association/

American Society for Preventive Cardiology/National Medical Association/ Preventive Cardiovascular Nurses Association.

TeleHealth Assisted Interventions-Home BP Monitoring (THAI-HBPM)

(by using HBPM+ABPM)

Treatment and Control of HT :

Why TeleHealth Assisted Intervention-

Home Blood Pressure Monitoring ?

Lessons from THAI-HBPM

Hospital-based Screening and Diagnosis +

Lessons learn from 2013 & 2014 HBPM training

H. = no. of Hospitals HBPM Training

2013(n=60 H.) 2014(n=35H)

Health professional attended training

0 MD, 182 nurses

0 MD, 100 nurses

Devices provided 0(manual) 0(manual)

Online job training no no

H. with HBPM report @ 6-month 10(16.7%) Not available

Screening BPM @ 10-month 1,800 Not available

HBPM data @ 10-m. Not available Not available

White-coat HT HT with WC effect

Not available Not available

Not available Not available

Drs & Nurses THAI-HBPM training at KCMH 10 - 11 Aug 2016

National Health Security Office (NHSO) Chulalongkorn University & Hospital Heart Association of Thailand Thai Hypertension Society

การจดอบรมใหความรการดแลรกษาโรคความดนโลหตสงและสรางเจตนคต การวดความดนฯ

และระดบน าตาลในเลอดดวยตนเองทบาน แกบคลากรทางการแพทย

หองประชม ตกภมสรมงคลานสรณ โรงพยาบาลจฬาลงกรณ

วนท 10-11 สงหาคม 2559

3 Years

TeleHealth Assisted Interventions-Home Blood Pressure Monitoring (THAI-HBPM)

Start 12th Aug 2016

Lessons learnt from 2013 & 2014 HBPM training

H. = no. of Hospitals HBPM Training

2013(n=60 H.) 2014(n=35H)

Health professional attended training

0 MD, 182 nurses

0 MD, 100 nurses

Devices provided 0(manual) 0(manual)

Online job training no no

H. with HBPM report @ 6-month

10(16.7%) Not available

Screening BPM @ 10-month

1,800 Not available

HBPM data @ 10-m. Not available Not available

White-coat HT HT with WC effect

Not available Not available

Not available Not available

2013, 2014 and 2016 HBPM training

H. = no. of Hospitals HBPM Training

2013(n=60 H.) 2014(n=35H) 2016(n=88 H.)

Health professional attended training

0 MD, 182 nurses

0 MD, 100 nurses

66 MD, 172 nurses

Devices provided 0(manual) 0(manual) 760(Tele-HBPM)

Online job training no no LINE, YouTube

H. with HBPM report @ 6-month

10(16.7%) Not available 58(65.9%)

Screening BPM @ 10-month

1,800 Not available 1,362

HBPM data @ 10-m. Not available Not available 1,000

White-coat HT HT with WC effect

Not available Not available

Not available Not available

14.9% 34.2%

HBPM training 10-11 Aug 2016

30 Jun 2017 (10+ months after training)

n = 1409 cases N = 65 Hospitals

(52 Provinces from 75 Provinces in 13 regions)

รพ.อตรดตถ

รพร.สวางแดนดน

รพ.ประจนตคาม

รพ.อาวลก

รพ.ไชโย

รพร.ทาบอ

รพ.เดมบางนางบวช

รพ.ปากพะยน

รพ.พนมสารคาม รพ.พทธโสธร

รพ.สอง

รพ.บอไร

รพ.อางทอง

รพ.วชระฯ

HBPM รพ.ระดบ “ด” ๑๐ อนดบ

BP Champion Award 2017 “ดเยยม” ประจ าภาค

ม HBPM ในรพ.

European Society of Hypertension Guidelines for BP monitoring at home. Parati G. J Hypertens 2008;26:1505

(NM)

(WC)

(MK)

(HT)

Untreated (No Anti-HT) Treated (On Anti-HT)

Hypertension

with

white-coat effect

(WE)

Sustained

hypertension

(SH)

Controlled

hypertension

(CH)

Masked

Uncontrolled HT or

Hypertension

with

masked effect

(ME) SBP and DBP SBP and/or DBP SBP and DBP SBP and/or DBP

Resistant HT (RE if >3 anti-HT with 1 diuretic)

TeleHealth-Assisted-Intervention-HBPM (Hospital-based)

@ 12-month follow up: n = 1,464(1,094 analyzed), 65 Hospitals

Normotension

36(19.9%)

(NM)

White-coat

Hypertension 29(16.0%)

(WC)

Masked

hypertension 15(8.3%)

(MK)

Hypertension

101(54.5%)

(HT)

No Anti-HT: n = 181,16.5% On Anti-HT: n = 913, 83.5%

293(32.1%) Hypertension

with

white-coat effect

(WE) (WE1D n = 89, 9.7 %)

268(29.3%) Sustained

hypertension

(SH)

242(26.5%) Controlled

hypertension

(CH)

110(12.1%)

Hypertension

with

masked effect

(ME) SBP and DBP SBP and/or DBP SBP and DBP SBP and/or DBP

12 Aug 2017

KPI กระทรวงฯ

ตวชวดทดกวา CBP

(RE n = 106, 11.6%)

(?OSA n = 86, 9.4% )

โครงการการคดกรองและวนจฉยความดนโลหตสงในชมชน เพอการปองกนโรคหลอดเลอดสมอง ดวยการวดความดนฯท

บานโดยใชเทคโนโลยสารสนเทศ Screening and diagnosis of hypertension for stroke prevention

in communities by TeleHealth Assisted Intervention-Home Blood Pressure Monitoring: Screening and Diagnosis

(Community-based & Home-based)

วนท 20 เมษายน ณ. หองประชมสาขาวชาอายรศาสตรหวใจและหลอดเลอด จฬาฯ ชน M อาคารภมสรฯ

ศนยบรการสาธารณสขท ๑๖ และ ๒๑ กทม. รพ.นครนายก สสจ.เชยงราย กระทรวงสาธารณสข

Drs., Nurses and Village Health Volunteers HBPM training At Maechan Community Hospital, 30 - 31 Mar 2017

Nakornnayok Hospital

BKK Health Center16

BKK Health Center21

Ambulatory Blood Pressure Telemonitoring: Hypertension screening and Dx from anywhere in 1 day

HT Screening Time for Dx Rx&FU

BP 1.0 Y >1/2 month CBP BP 2.0 Y >1/2 month CBP BP 3.0 Y 4-7 days HBPM

BP 4.0 Y 4-7 days HBPT BP 4.1 Y 6-24 hours ABPT

Home Blood Pressure Telemonitoring with timer = ABPT

Take home message (หอกลบบาน)

• ABPM & HBPM recommended for

– Screening & Diagnosis of HT

– Rx & Follow up

• TeleHealth Assisted Interventions for

– Training(Connect trainees to trainers)

– Treatment(Connect pts. to physicians)

– Tracking(Connect… to ...)