global paradigm shift in approach to cardiovascular disease a. thomas pezzella, m.d
TRANSCRIPT
Global Paradigm Shift Global Paradigm Shift in Approach to in Approach to
Cardiovascular DiseaseCardiovascular Disease
A. Thomas Pezzella, M.D.A. Thomas Pezzella, M.D.
World Heart Foundation/
International Children’s Heart Fund
A. Thomas Pezzella, M.D., F.A.C.S.
James L. Cox, M.D. - World Heart Foundation
Albert Einstein - Nobel Prize - 100 years - 1905
Brownian Motion - Factuals
Bill Gates Foundation
57 Million Deaths Worldwide in 200257 Million Deaths
Worldwide in 2002
Communicable disease 18.3 million
Noncommunicable disease 33.5million
Trauma 5.2 million
CV disease 17 million
– Ischemic 7 million
– Rheumatic 400,000
– Congenital 300,000
Cardiac Cases WorldwideCardiac Cases Worldwide
0200400600800
100012001400
1222
786
569
169 14737 25 18
Nu
mb
er
of
Cases p
er
Million
Preventive
Medicine
Curative
Medicine
Traditional Approach
Traditional Preventive Strategies
Infrastructure
Bricks and mortar
Vaccination
Primary Care
Hospitals
Medical Centers
Medical Education
The D-Day Approach
Key themes of modern public health practiceKey themes of modern public health practice Leadership of the entire healh system
Collaborative actions across all sectors
Multidisciplinary approach to all determinants of health
Political engagement in development of public health policy
Partnership with the populations served
The Lancet 2004;363:285 (www.thelancet.com)
Product Line
Disease Specific
Conflict/Competition/Collaboration
Continuum of Care
Integrated Approaches
Prevention Promotion
Diagnosis Treatment Rehabilitation
Individual with
Disease
High Risk Individual
Family
Society
Type of Intervention
Societal Policies which create an environment that promoteshealth.Family and intergenerational level prevention to promote healthy lifestyles through all stages of life.
Primary Prevention by controlof risk factors
Secondary Prevention measures
High tech interventions in thevery sick, high risk individuals with CVD.Multilevel integrated strategies for the prevention of CVD. The size of
the box approximates the relative size of the population impact.
TERTIARY HOSPITAL CARE(specialized services)
SECONDARY HOSPITAL CARE(hospital services)
PRIMARY HEALTH CARE(promotive, preventive, andbasic curative services athealth posts, health centers,and satellite clinics)
The health care dilemma in Ghana. The distribution of funds and personnel for primary healthcare compared to costly hospital-based care is in inverse proportion to the numbers of peoplethat need to be reached. The health care pyramid for Ghana is upside down!
Population to be served
Health expenditures*
*Approximations based on1975-1976 annual estimates
$50,000,000
(45%)
$45,000,000
(40%)
$9,000,000
(90%) $17,000,000
(15%)
100,000 (1%)
900,000 (9%)
If I can stop one heart from breaking,
I shall not live in vain;If I can ease one life the aching,
Or cool one pain,Or help one fainting robin
Unto his nest again,I shall not live in vain.
Emily Dickinson
Vascular
Endocrine
GI
Vascular
Endocrine
GI Vascular
Endocrine
GI
Radiology
Medicine
Surgery
Radiology
Medicine
Surgery Radiology
Medicine
Surgery
Surgery
Medicine Radiology
GI
Endocrine Vascular
Traditional (Department-Based) Practices Disease-Based Practices
Global Strategy
Research\Developme
nt
Administrative\Political\Logistical
Clinical
Home
Abroad
Educational\
Training
Global Strategy
Clinical
Home
Abroad
Selected referrals abroad
Regional hubs
Donor/host relation
Global Strategy
Educational\
Training Teaching teams in country
Internet
Regional consultants
Telemedicine
Selective training abroad - short term
GPS NAVSTAR Global
Positioning System
Copy/paste
Plug/play
Internet
Global Strategy
Research\Developme
nt
Bench/Bush/Bedside
Yacoub Model
Where pathology is?
Ethical considerations - Helsinki principles
Global Strategy
Administrative\Political\Logistical
Strategy
Organizational chart
Memorandum of Understanding
Ego/Money
Marketing
Equipment/Supply - Inventory
Health care “poaching”
Medical Personnel Diaspora
The Planet - No Boundaries
Terns
Wildebeest
N. AMERICA
USA
Canada
Central America
- Mexico
- Central
- Caribbean
S. AMERICA
EUROPE
Western/Eastern
North Africa
Middle East
AFRICA
West/Central
East/South
- China
- Mongolia
- Tibet
India
Pakistan
Australia/ New Zealand
Pacific
Rim
Global Scheme
Types of ProgramsTypes of Programs
Upscale - learn from
Lateral - sister relation
Upgrade - need help, usually “stuff”
Rejuvenate - failed
De Novo - start from nothing
Upscale
Lateral
Upgrade
Rejuvenate
DeNovo
Prevention
Promotion
Diagnosis Treatment Rehabilitation
Horizontal ApproachTeamwork - Collaboration
Ego Money
# of cases$ reimbursement
salary - surgeon
# of CT surgeons
complexity-high risk
expectancy of good results
USACardiac Surgery
You can accomplish
anything in life,
provided that you do
no mind who gets the
credit.
Harry Truman
Objects in mirror
are closer than
they appear.