Package of essential noncommunicable disease (PEN) interventions in primary health-care settings in the Democratic People's Republic of Korea: A feasibility study.

Abstract

The prevention and control of noncommunicable diseases (NCDs) is a priority for the Democratic People's Republic of Korea. Mortality due to NCDs in people aged over 30 years was 1239 per 100 000 in 2009 and the 2014-2020 national strategy includes population-level goals for health promotion and disease prevention. This paper reports a pilot study on the feasibility of implementing components of the World Health Organization (WHO) Package of essential noncommunicable disease (PEN) interventions for primary health care in low-resource settings (WHO PEN) to enable early detection and management of cardiovascular disease and diabetes mellitus at the level of primary care. WHO PEN protocols were adapted for local use by household doctors, who provide ambulatory care in polyclinics in the mornings and household visits in the afternoons. The pilot project was implemented in two polyclinics in Pyongyang, covering a population of 32 000. After training, and during routine household visits in June 2014, 70 household doctors screened all adults aged over 35 years (18 340) for cardiovascular disease and diabetes mellitus, and their risk factors. A total of 2319 patients with cardiovascular disease or diabetes, and those with high-risk factors, were referred to the polyclinics for three quarterly visits for testing and management. Final household screening of the population was done in June 2015. This pilot project demonstrated the feasibility of integrating screening and management into the standard primary health-care system in the Democratic People's Republic of Korea. The household doctors were able to detect and manage risks for cardiovascular disease and diabetes by using the protocols based on WHO PEN. Among 18 340 individuals aged over 35 years, implementation of WHO PEN interventions led to a significant reduction in the number of people with a 10-year risk of cardiovascular disease ≥20% (from 1748 [9.5%] to 543 [3.0%]) over a 1-year period. Involvement of household doctors can increase access to services for prevention and control of cardiovascular disease and diabetes in the Democratic People's Republic of Korea.