INTRODUCTION AND AIM

Chronic Kidney Disease (CKD) and other related chronic non-communicable diseases (NCDs); Diabetes Mellitus, Hypertension (high blood pressure), Obesity and Heart Diseases are increasingly being recognized as a public health problem due to its associated adverse clinical consequences and raising costs of care. There is need for novel strategies in improving CKD/NCDs care and outcomes. NCDs Made Easy Program was developed in conjunction with the computer scientist and software developers. The platform has been on development over a period of 9 years. We designed this web based program to provide a simple tool for the care providers at the frontline (family doctors, GPs) and specialists to utilize evidence-based guidelines in the management of CKD and other NCDs. It is tested, piloted and validated through a community-based EGIPT-CKD screening program. It provides an electronic portal where demographic, clinical and laboratory data can be imputed to evaluate an individual renal and cardiovascular risk.

NCDs Made Easy Program targets community members, healthcare providers and policy makers hoping to impact on improving healthcare practice by easy and unique implementation of related evidence based NCDs guidelines. The program is based on complex equations and database for implementing guidelines according to the entered personal data. It can supports bridging the gap in NCDs daily practice in developing countries and as a helping too in primary healthcare system in developed countries.

The goals of the program are achieved through two integrated systems targeting NCDs management and education as follow:

A- NCDs Hospital Management System: NCDs Made Easy Program

NCDs Made Easy Program is an administrative program of management and following up of CKD/NCDs which provides a detailed kidneys and heart health risk assessment. It implements the evidence based guidelines for CKD/NCDs early detection and prevention with emphasis on the prevention, detection and management of its complications. Screening for kidney and cardiovascular risk assessment is carried out through a questionnaire collating information on demographics, lifestyle issues, medical history, clinical (blood pressure, physical measures), laboratory (urine dipstick, serum creatinine, proteinuria, lipid profile, diabetes profile, hemoglobin) and additional investigations (to assess complications of NCDs) if warranted. All of these data are linked to a database containing a coding system for the NCDs evidence based management guidelines.

Through this detailed participation, the user can know the health situation of the participant regarding:

• Diagnosis of NCDs, Framingham's heart score and metabolic syndrome. Diagnosis and recommended action plan for modifiable risk factors for initiation and progression of kidneys and heart diseases. Ideal blood pressure, ideal weight, ideal waist measurements with the current situation of diabetes and hypertension control if s/he has. If s/he has CKD, a detailed report regarding:
• Timing of follow up and referral.
• Avoiding acute on CKD. How to delay CKD progression and associated co-morbidities.
• How to delay CKD progression and associated co-morbidities.
• Diagnosis and management of CKD complications on bone, anemia, nutrition, general functioning and wellbeing, eyes, nervous system and awareness by NCDs.
• Referral notes to the appropriate specialty.
• Dietitian report according to participant's health status.
• Healthcare provider's report recommending the action plan and the suitable drug groups.
• Data collection: Countries, societies, institutions and hospitals can benefit from this program in data collection and statistical analysis by using this program. Every participant has an international code linked to the worldwide telephone codes. All personal data can be transferred coded to an Excel file (if required) to be used by any statistical program. This helps in estimation of NCDS prevalence and NCDs geographical information system which will impact on policy making to fight the disaster of NCDs.

B- NCDs Educational Website:

The program is provided with free educational tools to support CKD/NCDs awareness on different levels of care and different events as follow:

1. NCDs Awareness:

   Awareness by NCDs on a community level by provision of links and brochures covering all aspects of NCDs. Provision of resources of the updated evidence based guidelines caring by NCDs on physicians and nursing levels.

2. Check Your Health:

   This is a calculator for NCDs. It enables community members to know their health status for NCDs including obesity/overweight, diabetes mellitus, high blood pressure, cardiovascular diseases and chronic kidney diseases. Also this NCDs calculator can be used as a training tool for students and junior doctors regarding the identification of NCDs diagnosis.

3. Clinical Laboratories:

   Glomerular Filtration Rate calculator: this enables clinical laboratories to estimate and report Glomerular Filtration Rate (GFR) with serum creatinine. This will impact on early detection of kidney disease and optimal timing for referral to nephrologists.

4. NCDs Days Celebration Tool:

   This is a rapid kidney and heart health risk assessment. It enables screening for NCDs and recommends an action plan for its early detection and prevention. It takes only 5-7 minutes participation/person which is suitable for community awareness as in World Kidney Day, World Diabetes Day and World hypertension Day.

PROGRAM OUTPUT

Every participant has a unique code for identification. After saving his/her visit's data, the participant will get 3 medical reports in addition to statistical preview:

• Participant's report: through it she/he will know his health status regarding diagnosis of NCDs, target blood pressure, and weight and waist measures, save kidneys and heart (through listing of her/his modifiable risk factors and recommending her/his personal action plan), evaluation and management of CKD complications (if there is CKD), awareness by NCDs, preparation for renal replacement therapy and referral for initiation of RRT according to GFR level.
• Dietitian's consultation form: it summarizes the dietary recommendations according to the current visit details aiming to help dietitian in dietary prescription.
• Healthcare provider's referral letter: including NCDs diagnosis and recommended action plan according to the personal data matched with the evidence based guidelines including KDOQI, KDIGO and ISN GO research and prevention program guidelines.
• Statistical preview: all visit details, investigations done and calculations processed will be transferred coded to an Excel file linked to the program for statistical purposes to avoid data entry errors and saves time and cost.

APPLICABILITY:

NCDs Made Easy Program can support:

• Primary healthcare system regarding NCDs daily practice
• Diabetes and hypertension outpatient clinics
• Nephrology outpatient clinics

CONCLUSIONS:

NCDs Made Easy program has proved useful for:

• Early identification of at-risk persons for CKD/CVD,
• Optimal control of modifiable risk factors,
• Diagnosis of NCDs,
• Avoiding nephrotoxic drugs,
• Use of ACE Inhibitors/ARB's,
• Early referral to nephrologists,
• Optimal management of pre-ESRD patients,
• Increase awareness by NCDs (on community, dietitians and healthcare providers' level).
• It is cost effective,
• Can link to different screening facilities worldwide through a universal database and that can help organizations and societies with chronic diseases surveillance.

Save Kidneys and Heart Program (NCDs Made Easy Program) is one of the initiatives of EasyMed Company, Egypt in the field of NCDs provided by Dr. Zaghloul Gouda (consultant nephrologist) and Dr. Ghada Mashaal (consultant nephrologist): nephrology department, Damanhour medical national institute, Damanhour city, Egypt.

For more information, kindly access invitation for participation or directly contact program authors.

Authors: