ehealth Checkup and Tele- Consultation Program in Bangladesh

Transcription

1 The 8 th Asia Telemedicine Symposium (12 nd Dec, 2014) ehealth Checkup and Tele- Consultation Program in Bangladesh Naoki Nakashima MD, PhD Professor/Director of Medical Information Center Vice Director of TEMDEC Kyushu University Hospital

2 2 Aims As the top runner of aging society in the world, Japan has a strong motivation to develop solutions about this issue. To conduct a study of a preventive medical service in a developing country, combining e- health checkups and tele-consultation as well as assess stratification rules, and to evaluate the short-term effects of intervention.

3 Concept of the project

4 Bangladesh Strategy for Population Management of NCD Portable Health Clinic project Health checkup by a sensor set Stratification and health guidance by leaflet healthy caution sick emergent Healthcare Field Primary Prevention Telemedicine (Tele-mentoring, tele-prescription) Move to Medical field Medical treatment Medical (Local healthcare Field center) Continuous Telemedicine Secondary Prevention Tertiary Prevention Innovation by ICT

5 Why Bangladesh? Bangladesh Typical BoP country Clinicless/Doctorless in rural area 7 Billions Instead, Many Pharmacies with Cheap Generic Medicine Cellphone Service Covers Entire County (98%) Grameen Group in Bangladesh Research Cooperation Contract with Kyushu University Development of social business which has helped female independent living ( microcredit ) The leader Mr. Yunus won the Nobel Peace Prize in 2006 Willing to spread social business to medical field BoP

6 Methods

7 Portable Health Clinic (PHC) package in Attachecase (FY 2013 version) Barcode reader Buttery Name cards with barcode Thermo meter Hemoglobin Meter Digital Measure (Height, Waist, Hip) Pulse oximeter (Oxygen in blood) Urine tester tape (protein, sugar) Blood sugar meter Blood pressure Mobile printer Mobile modem Android terminal Weight scale

8 Heart Rate Heart Rate wrist Respiratio LUX db Deg C %RH Status(Be : : : : : : : : : : : : :00 time Heart Rate wrist Heart Rate Respiratio Status(Bed %RH Deg C db LUX : : : : : : : : : : : : :00 time BANGLADESH PORTABLE HEALTH CLINIC (PHC) PROJECT AN AFFORDABLE, USABLE, SUSTAINABLE AND PREVENTIVE HEALTHCARE SYSTEM FOR UNREACHED PEOPLE Stratification by results of health check-up by portable clinic healthy;none caution;leaflet sick;telemedicine emergent;telemedicine and visit hospital Triage Disease Management Office Call Center (by doctors) DB Sensors and network which are easy to operate (Grameen medical lady (Nurse staff) Ordinary, emergency Phone call phone Web Remote-prescription

9 Bangladesh Logic v2.0 (FY2013) Healthy Caution Sick Emergent Waist Male 90cm Female 80cm Waist/Hip Ratio Male 0.90 Female 0.85 Body Mass Index(BMI) <25 25 <30 30 < <180 < < (need double check) Blood Pressure (mmhg) 90 <110 <85 85 < (need double check) Fasting Blood Sugar 126mg/dl (Double <100mg/dl 100 <126 (FBS) check) 126mg/dl X 2times Postprandial Blood 200mg/dl (Double <140mg/dl 140 <200 Sugar (PBS) check) 200mg/dl X 2times Urine Protein ± + (Double check) Urine Sugar ± + Urobilinogen Normal or ± Positive or + ( Double check) Pulse Ratio 60 < <60 <50(Double check) 100 < (Double check) Arrythmia None + (Double check) Smoking None + Skin lesion None + Body Temperature < F <99.5 F 99.5F (37.5 ) 37 <37.5 (Double check) SpO2 96% 93 <96 90 <93 (Double check) <90% Hemoglobin 12g/dl 10 <12g/dl 8 <10g/dl <8g/dl

10 Results

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12 12 Subjects Period: July, 2012~March, 2014 Places: 5 villages and 9 factories Total unique subjects: 16,741 Visitors in FY2012 8,527 Visitors in FY ,575 Visitors in both FY2012/2013 2,361

13 Results of each checkup and final stratification by B-Logic v2.0(n=16741) 13 3% % % 54% 13% Waist Waist/Hip Ratio BMI Blood Pressure Blood Sugar Urine Protein Urine Sugar Urine Urobilli Pulse Rate Arrythmia Body Temp. SpO2 総合 Final

14 Comparison with Japan

15 15 Differences between Bangladesh and Japan BMI Waist Blood Pressure Blood Sugar Urine Protein BMI2 Waist2 BP BS2 uprotein value 50 BD JP BD JP BD JP BD JP BD JP 25 0 BD JP BD JP BD JP BD JP BD JP Var1 JP: from National Health/Nutrition Survey in 2013, and National Health checkup in Chiba prefecture in 2011 Age and Sex are adjusted Waist are compared by Japanese criteria of metabolic syndrome

16 16 Comparison of Urine Protein among areas (N=16741) n=1002 n=4464 n=4845 n=1328 n=1860 n=1954 n= Urine Protein We suspect contamination of arsenic or cadmium into ground water as cause of proteinuria(kidney damage) JP BD Japan Bangladesh

17 Effect of Health checkup and Telemedcine (after 1 year)

18 18 Remote medical consultation Affected(Orange /Red) Nonaffected(Green/ Yellow) total FY , ,736 FY , ,946 計 4, ,672 Patient in village site Doctor in the call center in Dhaka

19 19 Subjects Period: July, 2012~March, 2014 Places: 5 villages and 9 factories Total unique subjects: 16,741 Visitors in FY2012 8,527 Visitors in FY ,575 Visitors in both FY2012/2013 2,361

20 20 Change of systolic blood pressure (SBP) after 1 year (in each color by FY2012 SBP) Total n=2361 Green in FY2012(p<0.001) SBP difference after 1 year (mmhg) 1 年後の収縮期血圧差 [mmhg] 緑 (n=1529) 黄 (n=390) 橙 (n=410) 赤 (n=32) 1 年目の血圧判定色 n=1529 =390 =410 =32 112±10 111±12 Yellow in FY2012(p<0.001) 129±7 121±12 Orange in FY2012 (p<0.001) 141±13 130±16 Red in FY2012 (p<0.001) 181±28 153±30 SBP were improved even in the group with health checkout without health guidance

21 21 Change of blood sugar (BS) after 1 year (in each color by FY2012 BS) N= 2360 Green in FY2012 (p<0.001) BS difference after 1 年後の血糖値差 1 year (mg/dl [m g /d l] 96±15 104±22 Yellow in FY2012 (p=0.01) 158±17 152±64 Orange in FY2012(p=0.002) 234±26 193±69 Red in FY2012 (p=0.001) 405±85 270± 緑 (n=2224) 黄 (n=83) 橙 (n=33) 赤 (n=20) 1 年目の血糖判定色 n=2224 =83 =33 =20 Green group showed waist(80±10 81±9 cm, p<0.001)and weight(57±11 58±11kg p<0.001)were increased significantly.

22 Analysis for cost reduction

23 Trial to Reduce the Cost of Health Checkup By ROC(receiver operating characteristic) (Predict BS by questionnaire and other results of sensors) If we allow 7.3%(n=113) oversight, we can reduce 94.8% (n=14392) cost of blood sugar test ROC Curve by blood sugar vs. questionnaires and sensors We used Random Forest method with 60% of data for training data and 40% testing data. True Positive Youden s index AUC= AUC= False Positive

24 24 Summary of Bangladesh PHC project We conducted health-checkup followed by telemedicine on 16,741 people by mobile network with Japanese sensors We could survey about health condition of Bangladesh people Obesity, Diabetes, Hypertension, Kidney disease, etc High rate of proteinuria suggests pollution probably by heavy metal, etc (under estimation) The Service made people healthier SBP were improved in any stages after 1 years Hyperglycemia was also improved after 1 years Data analysis shown that we can decrease cost of health checkup if we allow oversight risk.

25 Thank you for your attention! Please ask me anything about the project by ; to