Sobhy SFL INDUSTRY MEETING EUROPCR 2011

Report
Stent for Life
Egypt
Country Champion
Prof.Mohamed Sobhy
President of Egyptian Society of Cardiology
Project Manager
Dr.Ahmed El Shal
Geography & Population
 Area = 1,002,000 km2
 Nile = 6500 km , the longest in
the world
 Red Sea coast = 995 km
 Mediterranean coast =1941 km
 Population ~ Million 82
 Population Growth Rate: 1.9%
 Net Migration Rate:
– 21 migrants/ 100,000 population
 Literacy = 71.4%
– Illiteracy decreased from 39.4% of population in
1996 to 29.3% in 2006
– Percentage of university graduates increased from
5.7% in 1996 to 9.6% in 2006
5
Egypt Population: Urban vs Rural
1907 - 2009
120
% of Population
100
80
60
56 56 57 57 59
60
62
72 66
73
79
83
40
Urban
Excluding Egyptians abroad
20
09
20
06
19
96
19
86
19
76
19
66
19
60
19
47
19
37
19
27
19
07
0
40 44 44 43 43 45
38
34
28
17 21 27
19
17
20
Rural
6
Current situation for Egypt
– pPCI rate is around 5 – 8 %
– No accurate data available
– Different types of hospitals :
•
•
•
•
–
–
–
–
University hospitals
Military hospitals
Government/medical insurance hospitals
Private hospitals
National EMS number exists but is not widely used
Government hospital cathlabs are not open 24/7
Private hospitals are well structured some of them cathlabs available 24/7
Patient are not aware of AMI symptoms and importance of Time. Patients
rather wait for “their” physician
– Interventional cardiology is a rather new discipline
– Lack of overall awareness with key stakeholders on “Time is muscle” for AMI
patients
Reperfusion Therapies
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
7
1
14
0
12
7
17
2
13
12
20
10
15
25
26
15
26
36
5
15
3
21
30
39
40
31
8
35
44
37
42
48
52
50
10
50
63
40
15
15
92
35
55
35
28
86
81
81
26
75
75
72
70
66
64
30
44
25
33
59
41
49
45
45
35
33
30
30
28
24
23
19
19
9
CZ
SLO
DE
CH
NO
DK
PL
HR
P-PCI
SE
HU
BE
IL
IT
FIN
Thrombolysis
45
29
AT
FR
SK
ES
LAT
UK
BG
PO
SRB GR
8
5
TR
RO
No reperfusion
P.Widimsky et al. November 19, 2009. Reperfusion therapy for ST elevation acute myocardial infarction in Europe:
description of the current situation in 30 countries. Eur. Heart.J.doi:10.1093/eurheartj/ehp492
Egypt
Current situation : patient pathway
Patient
•Only ambulance from specialised
cardiac hospitals have a physician on
board
•Not properly trained
•ECG only on board in new ambulances
•No clear unified protocol
•Will drive patient to nearest hospitals
•If private insurance : will go to private
hospital
•Calls cardiologist
•Calls private
hospital
•Calls physician from
private insurance
•Calls EMS
•DENIAL
EMS
cathlab
ICU
Local hospital
Home
•Not all are open 24/7
•Lack of awareness of
how to treat an AMI
patient
•Cathlab not prepared
for AMI patients
•Logistic obstacles
SFL Project proposal
– Country steering committee with key stakeholders
•
•
•
•
•
•
spokespeople for projects – communicate with media, during congresses and with government
Select people who endorse, support and drive the projects
Key spokesperson : Prof . Mohamed Sobhy
National coordinator/ Project manager : Dr Ahmed El Chal
Liaise with central SFL committee
Representatives of sponsoring companies
•
•Task forces in 5 regions
– Alexandria :
• best organised region
– Great Cairo region :
• already individual projects in 3 University hospitals and a project in the National Heart Institute
on AMI data gathering
– Delta region and Upper Egypt :
• rural areas, key focus areas for government
– Military Hospitals Group :
• strong network, very disciplined, low on bureaucracy, easy to implement protocols
SFL Project proposal
•For each region :
– decide on key stakeholders
– Presentation to “sell” concept to make sure everyone
agrees and sees the importance of the project
– Stakeholders need to decide on Task Force
– Select pilot center and develop into “centre of excellence”
– Work with “train the trainer concept”
– Develop detailed plan
– Gather baseline data
– Develop budget
– Set clear objectives Define milestones and deliverables
– Put measurements in place
– Regular feedback into country Steering Committee
Stent for Life Project – Egypt
Objectives
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Integrate SFL into National Cardiology Program
Build Regional Network and Infrastructure (EMS)
Optimize Cath Lab Staffing and Work Organization
Allocate Budget (Procedure reimbursement & 24/7 staff remuneration)
Establish National ACS/AMI Registry
Increase Disease Awareness (Educational campaign to government, payers and lay public)
EMS staff training is more important that the EMS staff structure (trained nurses suitable for the
triage and transport of AMI patients)
EMS ambulances: equipped by resuscitation facilities and by a portable 12-leads ECG.
Raising public awareness about heart attacks and importance to reach the nearest medical centre.
Criteria of selection of patient receiving PCI for SFL program.
Create a database of current PPCI practice patterns in Egypt in order to serve as a benchmark for
further assessment.
Improve the performance of centers doing PPCI.
Adequate training of ER & all concerned staff.
Increase patients awareness of the seriousness of chest pain & the dangers of delaying adequate
medical care.
Improving emergency services with regional maps for different centers.
Stakeholder management
Barriers :
No clear mapping
cath labs/population
Lack of knowledge and implementation of ESC guidelines
Mindset change : IC is also a discipline that needs to be available 24/7
Infrastructure change
cathlab 24/7
clear protocol for EMS
Action items
Mapping
Continue with training on ESC guidelines
Use local meetings /symposia/media to create awareness
Select projects that give “quick” results – communicate results
Organise local stakeholder meetings to get buy-in from start
Achievements Since SFL initiative Declaration in Egypt
14th October 2010
• Approval of project from Egyptian Society of
Cardiology to secure National endorsement.
• Establish the local SFL Steering Committee (12)
and Task force committee (42)
21st November 2010
• Meeting of Prof.Fajadet ,Mrs. Zuzana Kaifoszova,
Prof.Sobhy with medical Companies managers to
introduce the project in Egypt and secure
sponsorship.
25th of November 2010
•
1st meeting for Steering committee & Task force committee






Set Project objectives ,Project outlines
Meeting by region including member allocated from Steering & Task force
committees :
Current situation in Egypt , Determine each region tasks and ideas.
Decide on key stakeholders
Select pilot center and develop into “centre of excellence”
Brain storming for a detailed plan , Gather baseline data
26th of November 2010
•
Meeting for committees with Minister of Health in Egypt &
Ambulance Service Manager



Presentation to “sell” concept to make sure everyone agrees and sees the
importance of project
Develop 2011 action plan around key barriers
and success factors
Set clear objectives
(1) Need
Registry to
give ideas
(5) ER plan
ministry of
Health
Gathering
Baseline Data
(4) Training
programs for
PPCI & ER
(2)
Ambulance
capacity for
geographic
distribution
(3) Quality of
ambulance
contact
center for
refer
Revolution of 25th of
January 2011 in Egypt
delayed the start of
Action Plan due to some
social, administrative
and political obstacles.
12th of May 2011
•
2nd meeting for Steering committee & Task force committee
Plan of Action- Strategy
•All details to be achieved over 3 quarters of the year
instead of 4.
•Working in all Network items in same time.
•Start a media campaign in same time to gain
all positive effects from Egyptian revolution .
•Unifying cost of pPCI
(Companies-Medical insurance)
Details of Plan of Action in 2011
1- Registry and Questionnaire / Data base
collection
Registry and Questionnaire / Data base collection
•Delivery of the questionnaire Approved from SFL
European board.
•Minimum of 100 questionnaires from each
center/university.
•Minimum of 10 questionnaires from each committee
member(apart from center/university data)
•Registry and Questionnaire Launched during 2nd
Meeting of Steering and Task Force committees on
12th of May 2011.
•Deadline of questionnaires’ collection 20/9/2011
Details of Plan of Action in 2011
2- Guidelines implementation and Physician
Activity
Region
Dates
Target attendees
Education
Physician Education
Program
ESC Guidelines
implementation
SFL session in
conferences
Physician Education
Program
ESC Guidelines
implementation
Physician Education
Program
SFL session in
conferences
ESC Guidelines
implementation
Satellites meeting
EMS staff education
program

Delta and Alexandria region



Great Cairo region
Non Invasive
Cardio Alex 2011 ( 3
sessions)

Upper Egypt region


Delta and Alexandria region
Non Invasive

Delta and Cairo region

Cardio Egypt 2011


Upper Egypt region
Non Invasive

ACS/PCI guidelines in
different governorates
1st minutes dealing with
patient.
Referral to right hospital


4-5/5/2011
Alexandria
12-13/5/2011
Cairo
7-10/6/2011
Alexandria
21-22/7/2011
Hurghada
14-15/7/2011
Alexandria
8-9/9/2011
Alexandria
19/10/2011
Sharm El Sheikh
8-9/12/2011
Hurghada
Monthly basis
300 cardiologists and
GPs
400 cardiologists
300 cardiologists and
GPs
250 cardiologists and
GPs
400 cardiologists
300 cardiologists and
GPs
300 cardiologists and
GPs
250 cardiologists
50 cardiologists and
GPs
20 EMS staff in 5
Monthly basis
governorates
Details of Plan of Action in 2011
3-Pilot center- Pilot Centers’ Inspection and
Audit
committee
•Pilot
center detection
•Announcement for Requirements
•Application form to be sent to centers (upon centers
request to be a pilot center)
•Approval of centers applicants Qualifications from the
nominated committee.
•Pilot Centers’ Inspection and Audit committee (PCIA)
Prof.Sherif El Tobgy
Prof.Mahmoud Hassanein
Prof.Yehia Kishk
Prof.Tarek Zaki
Prof.Saeid Shalaby
** Duties
of PCIA committee
•PCIA committee will approve the qualifications of
applicant pilot centers.
•PCIA committee will organize 2 visits in 2011 for
inspection of applicant pilot centers .
•PCIA committee will report to steering committee of
pilot centers evaluation.
Details of Plan of Action in 2011
4-Media campaign
Activity
Target
Dates
13/5/2011
Cairo
12/2011
Cairo
Press conference

Public and physician
Press conference

Public and physician
Sms campaign

Physician
10/5/2011
Sms campaign

Public and physician
5/6/2011
Website Launch

Physician
10/5/2011
Special SFL leaflet
launch

Public
7/6/2011
SFL public Meeting

Public forum
10/6/2011
SFL public Meeting

Public forum
8/2011
Plan of Action in 2011 – Follow up
Committees meetings:
Cairo : 12 May 2011
Hurghada : 21 July 2011
Sharm El Sheikh : 18 October 2011
Alexandria : December 2011
Meeting with Sponsors
Cairo : 12 May 2011
Alexandria : 14 July 2011
Sharm El Sheikh : 18 October 2011
Alexandria : December 2011
Thank you….
See you next year!
June 2012

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