China Expands Grassroots Clinic Prescribing As Cardiovascular Epidemic Looms

In fresh move to reduce reliance on large hospitals to combat the challenge of chronic diseases, China is to allow community clinics to dispense the same drugs as larger hospitals, just as a new Harvard report projects an epidemic of heart disease and stroke in the country.

By the end of this year, Beijing residents visiting their neighborhood clinics will have the same selection of prescription drugs to treat their chronic diseases as they would if they traveled to visit a top-tier Class AAA hospital.

The decision, announced on Aug. 15 by the city's health officials, marks a renewed push for the government to elevate health clinics, in an effort to discourage patients from seeking routine health services at the large hospitals.

Clinics will add 105 treatments to their shelves, for chronic diseases including hypertension, diabetes, coronary heart disease and cerebrovascular conditions.

Before the year end, Beijing will add 105 treatments to the shelves of the clinics; they are for chronic diseases including hypertension, diabetes, coronary heart disease and cerebrovascular conditions. And these are either fully or partially reimbursed drugs. Drugs listed as essential drugs are 100% covered, and others are covered by a certain portion.

At the moment, the Beijing government reimburses a total of 2,510 drugs, and all of them are available at large hospitals. However, only 1,435 drugs are available at community clinics, which are much smaller in size but strategically located inside communities across the vast city.

In addition to the wider drug range, patients will also be able to get their drugs prescribed at a community clinic for as long as two months, providing they meet certain qualifications. These are having a stable condition; having set up electronic health records; having a diagnosis from a Class AAA hospital; and taking one drug regularly.

The next step is to have all the 2,510 reimbursed drugs available at the clinics. "With the policy adjustment, all drugs that are covered by hospitals will be able to get reimbursed at clinics," said Yang Jing, deputy director of Beijing City Medical Insurance Bureau.

The policy Yang cited is a new directional push for China's Healthcare Reform. In a proposal to deepen the reform, which has nurtured nearly 95% basic health insurance coverage and 20% annual growth rate for healthcare industry, World Health Organization said the next stage should be "people-centric" reform. (Also see "WHO’s Chan Outlines ‘Chinese Dream’ For Health Care Reforms" - Pink Sheet, 2 Aug, 2016.).

One of the measures is to reform public hospitals, making these specialized to treat intractable and major diseases rather than the current “one-stop service,” switching routine basic care services to grassroots facilities.

The swift switch of priority to grassroots facilities has seen multinational drug makers including Eli Lilly, Novo Nordisk and Sanofi establish dedicated teams and penetrate in a segment that has been largely dominated by domestic firms.

Heart Disease Epidemic

Meanwhile, Harvard University T H Chan School of Public Health has released a study report, calling attention to an epidemic of cardiovascular diseases in China.

Authors of the Aug. 15 report say that a more western diet and rapid urbanization have contributed to a jump in heart diseases and strokes.

Drawing data from 26,000 people living in nine Chinese provinces, as part of the China Health and Nutrition Survey, Harvard researchers found the most prevalent risk factors are increase in hypertension, high cholesterol, and high blood glucose. The three conditions were attributed to 3.1 million, 1.4 million and 0.9 million new cases of heart attack or stroke, respectively in 2011, the authors said.

In addition, decreased physical activity was associated with a 0.7 million increase in CVD cases and rises in BMI were associated with a 0.6 million increase in CVD cases in the year.

Smoking alone was associated with 1.3 million CVD-related cases – roughly a third of the CVD burden in men. "Our estimates suggest that the continued rise in high blood pressure, an increasingly sedentary lifestyle, increasing obesity, and worsening dietary trends will add millions of new cases of heart attacks and stroke over the next two decades," said Li Yangping, research scientist at Harvard Department of Nutrition and a lead author.

The situation is further complicated by increase in obesity and type 2 diabetes.

The study authors also call for a public health policy to focus on prevention. “It’s imperative to continue to monitor the problem, which has serious social and economic consequences. Prevention of chronic diseases through promoting healthy diet and lifestyle should be elevated to a national public policy priority.” said Frank Hu, Harvard nutrition and epidemiology professor in a statement.

Selected Drugs Newly Added To Community Clinics
Hypertension	Diabetes	Coronary Heart Disease	Cerebrovascular conditions
Amlodipine	Glyburide	Clopidogrel	Aspirin
Valsartan	Glipizide	Cilostazol	Warfarin
Irbesatan	Glibenclamide	Metoprolol	Doxepin
Bisoprolol	Methaqualone	Atorvastatin	Valproate
Losartan	Insulin analogues	Fluvastatin	Flupentixol melitracen
Enalapril	Metformin	Pravastatin	Mirtazapine
Felodipine	Acarbose	Simvastatin	Sertraline
Nitrendipine	Voglibose	Dosuvastatin	Paroxetine
	Repaglinide,	Pitavastatin	Citalopram
	Pioglitazone	Fenofibrate	Donepezil
	Short-acting insulin	Ezetimibe	Nicergoline
	Intermediate-acting insulin	Probucol
	Premixed insulin, premixed insulin analogues
Source: Beijing Health and Family Planning Commission, Pink Sheet

From the editors of PharmAsia News.