Ahmed Aboulghate, MBBCh, MPhil

University of CambridgePhD student, Cambridge Overseas

Scholar

Developing Quality Indicators for the Egyptian

Primary Care System

Egypt; backgroundPopulation 73 million

Lower-middle income country

(Poverty level 16.7%)

Dual burden of disease.

National Burden of Disease

NCD 74%

Communicable 9%

Injuries 7%

Others 10%

Leading contributors to National Burden of Disease

Ischaemic Heart Disease 11 %

Unipolar Depression 5 %

Asthma, COPD 4 %

Cerebrovascular Disease 4 %

Respiratory Infections 3 %

Cataract 3 %

Adult Onset Hearing Loss 3 %

Hypertensive Heart Disease 3 %

Drug Use Disorders 2 %

Liver Cirrhosis 2 %

Egyptian Health Care SystemSocial insurance

• Free for eligible patients (48% of population) • Employees, infants, school children, pensioners, widows

State run facilities• Everyone is eligible• Limited resources, low quality

Private sector• Out of pocket (60% of national health expenditure)• Serves all population categories• Varying quality and price

1997: Health Sector Reform Project

Universal coverageHigh qualityEquityEfficiencySustainability

To shift the focus of care from heavy reliance on inpatient care to a more integrated and less costly primary care model. (Berman et al, 1998).

Reforming the Primary Care

Infra structure:Renovating and building PC facilitiesToday: 5500 PC facilities

Care providersFinancial and career incentives

Quality controlAccreditationPay for performance through Quality Indicators

Current Indicators in the Egyptian Primary Care

Type Number of indicators included

Total 34

Structure 25

Process 6

Outcome 3

Limitations of the current indicators

• Emphasis on ‘structure’ indicators• ‘Process’ indicators are vague and broadly defined• Scores are manually collected through inspection

visits

Aims of the study

NOT TO: Copy and Paste indicators (e.g. QOF)BUT TO: Transfer technologies and methods

Methodology1. Choose the medical conditions2. Develop indicators for them3. Pilot the new indicators

1. Choosing the conditions

The most common conditions presenting to primary care units

Primary data collection>2000 patients12 primary care units

National Burden of Disease

Basic Benefit Package

2. Developing the indicators

The RAND/UCLA appropriateness methodLiterature and guidelines reviewDeveloping preliminary set of indicatorsRating the indicators by a group of local expertsPanel meeting to discuss and re-rate the indicators

Indicator Quality of evidence

References Benefits/ summary

Necessity Validity

Patients with CAD should be advised to take aspirin at a dose of 75-100 mg/day unless contraindicated

I

Yusuf et al, 1998ATC, 1994

Absolute reduction in vascular events of 5%

(1-9) (1-9)

3. Piloting the indicators

Extracting Indicators scores from patients records

Testing the time and resources required to extract

the indicators

Testing the inter-rater reliability

Opportunities

Measure the feasibility of applying the new indicators

Propose modifications to the electronic recording system to implement automated indicator score calculation

Building a culture of Evidence Informed policy making

Thank you