This paper seeks to explore the relevance between the Western 'expert patient' rhetoric and the reality of non-communicable diseases (NCDs) control and management in low and middle income settings from the hea...This paper seeks to explore the relevance between the Western 'expert patient' rhetoric and the reality of non-communicable diseases (NCDs) control and management in low and middle income settings from the health sociological perspective.It firstly sets up a conceptual framework of the 'expert patient' or the patient self-management approach, showing the rhetoric of the initiative in the developed countries.Then by examining the situation of NCDs control and management in low income settings, the paper tries to evaluate the possibilities of implementing the 'expert patient' approach in these countries.Kober and Van Damme's study on the relevance of the 'expert patient' for an HIV/AIDS program in low income settings is critically studied to show the relevance of the developed countries' rhetoric of the 'expert patient' approach for the reality of developing countries.In addition, the MoPoTsyo diabetes peer educator program is analyzed to show the challenges faced by the low income countries in implementing patient selfmanagement programs.Finally, applications of the expert patient approach in China are discussed as well, to remind us of the possible difficulties in introducing it into rural settings.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).展开更多
Non-communicable diseases (NCDs) are a leading cause of deaths and of disease burden in China.This paper analyzes the rationale and implications of a community-based approach to a better coordinated NCDs care and mana...Non-communicable diseases (NCDs) are a leading cause of deaths and of disease burden in China.This paper analyzes the rationale and implications of a community-based approach to a better coordinated NCDs care and management system in China.As argued by the author, the buildup of an integrated NCDs care delivery system is feasible now and large health expenditures will be saved if more stable outpatients with NCDs could be shifted to community health facilities to receive their medications.However,the key issues remain in building a general practitioner led (GP-led) primary care delivery system in China.Some prominent issues include the shortage of quality generalists, lack of proper incentives and management mechanisms, and the absence of patients and provider, and restrictive arrangements in basic health insurance policies.Even with these hard-to-solve issues, some recent reform initiatives for integrated NCDs care delivery in some localities have demonstrated originality and creativeness in developing better coordination between primary and secondary NCDs care.However, without large-scale public sector reform, innate issues with human resource development, income distribution and financing of public healthcare providers cannot be solved.It may take a long time to see deep integration of primary and secondary NCDs care in China.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).展开更多
文摘This paper seeks to explore the relevance between the Western 'expert patient' rhetoric and the reality of non-communicable diseases (NCDs) control and management in low and middle income settings from the health sociological perspective.It firstly sets up a conceptual framework of the 'expert patient' or the patient self-management approach, showing the rhetoric of the initiative in the developed countries.Then by examining the situation of NCDs control and management in low income settings, the paper tries to evaluate the possibilities of implementing the 'expert patient' approach in these countries.Kober and Van Damme's study on the relevance of the 'expert patient' for an HIV/AIDS program in low income settings is critically studied to show the relevance of the developed countries' rhetoric of the 'expert patient' approach for the reality of developing countries.In addition, the MoPoTsyo diabetes peer educator program is analyzed to show the challenges faced by the low income countries in implementing patient selfmanagement programs.Finally, applications of the expert patient approach in China are discussed as well, to remind us of the possible difficulties in introducing it into rural settings.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).
文摘Non-communicable diseases (NCDs) are a leading cause of deaths and of disease burden in China.This paper analyzes the rationale and implications of a community-based approach to a better coordinated NCDs care and management system in China.As argued by the author, the buildup of an integrated NCDs care delivery system is feasible now and large health expenditures will be saved if more stable outpatients with NCDs could be shifted to community health facilities to receive their medications.However,the key issues remain in building a general practitioner led (GP-led) primary care delivery system in China.Some prominent issues include the shortage of quality generalists, lack of proper incentives and management mechanisms, and the absence of patients and provider, and restrictive arrangements in basic health insurance policies.Even with these hard-to-solve issues, some recent reform initiatives for integrated NCDs care delivery in some localities have demonstrated originality and creativeness in developing better coordination between primary and secondary NCDs care.However, without large-scale public sector reform, innate issues with human resource development, income distribution and financing of public healthcare providers cannot be solved.It may take a long time to see deep integration of primary and secondary NCDs care in China.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).
