Increasing Transparency to Promote use of Medicines for Secondary Prevention of Cardiovascular Disease
The WikiMeds project aims to evaluate the acceptability and feasibility of WikiMeds as a strategy for addressing the known barriers to the use of secondary prevention medications, using qualitative research methods.
Shusmita is a nutritionist by training and a public health worker by heart. Currently, she works as the coordinator/ director in the NCD unit of a Bangladeshi organization – Eminence – a member of the World Heart Federation. Through her works in Eminence, she has gathered proven ability in NCD related program design, implementation, reporting, and evaluation of health programs. Shusmita has experience in design and/or implementation for the collection of NCD related demographic and health surveys. Moreover, she has been the author/co-author of more than 10 conference papers and three peer-reviewed papers based on several epidemiological studies. In addition to her research-related activities, she works as the technical coordinator for the NCD-F and has been undertaking NCD related advocacy and communication activities like World Heart Day, World Hypertension Day and “Go Red for Women”.
Rasha is currently working towards her PhD focusing on access to medication and its use in lower-income countries at the Population Health Research Institute (PHRI), McMaster University. She previously worked at the Institute of Community and Public Health at Birzeit University in Palestine as a research assistant. Initially, her research was focused on the Palestinian health care system. Rasha participated in a situation analysis involving the investigation of current clinical guidelines, laws and strategies aimed at the prevention and management of CVD in Palestine and other Middle Eastern countries. As a PhD student, she was able to get funding for and conduct the Prospective Urban Rural Epidemiology (PURE) study in Palestine. Her prior experience working in Palestine provided her with the skills to create a PURE cite in Palestine, coordinate, and manage data collection for 1,500 participants. Currently, Rasha is involved in analyzing the PURE data from Palestine as well as 17 other countries at different stages of development. She is learning how to manage large epidemiology data and is developing methods to measure and compare access to CVD treatment in different regions of the world.
Gene is a cardiologist and global health researcher developing expertise in the intersection between these two fields. His primary professional goal is to push the frontier of global cardiovascular disease epidemiology and health service delivery (implementation) research through the development, implementation, evaluation, improvement, and dissemination of integrated chronic care programs in rural low- and middle-income countries (LMIC). Gene’s research stems from experience in the field in rural Rwanda and Haiti since 2008 in collaboration with local Ministries of Health and the non-governmental organization Partners In Health. He has developed and implemented care models and training curricula using the strategy of task-shifting: training in-country nurses and generalist physicians in simplified protocols to aid in specialty care for the diagnosis and management of NCDs including hypertension, diabetes, heart failure.
Dike was born in Delta State, Nigeria. He trained in basic medical education at Nigeria’s Premier University, the University of Ibadan, where he obtained his M.B; B.S Degree in 1995. Dike had Postgraduate Medical Training at University College Hospital Ibadan and obtained the Fellowship of West African College of Physicians in Internal Medicine with Special Interest in Cardiology in 2005. He also holds a Fellowship of the American College of Physicians since 2010 and Doctor of Philosophy Degree in Medicine (Cardiology) from the University of Cape Town, South Africa in the year 2013. Dike’s special areas of interest include Echocardiography, Hypertensive Heart Failure in sub-Saharan Africa, and Cardiovascular Risk Factors in Nigerian Hypertensive patients.
Francesco specialized in geriatrics in 2008 in the Geriatric Cardiology department (Director Prof. Niccolò Marchionni and Prof. Giulio Masotti). Since 2010 he has become a Medical Assistant in the Coronary Care Unit (CCU) of the Geriatric Cardiology Department of the Azienda Ospedaliero Universitaria Careggi (Florence main hospital). In 2006 Francesco started a collaboration with the ANMCO Research Center (the Research center of the Hospital Cardiologists National Society), directed by Prof. Aldo Maggioni with educational, clinical and research involvement. During these years he was particularly involved in the organization and management of observational studies and randomized clinical trials (GISSI AF and GISSI HF or the ongoing NIH founded ISCHEMIA trial).
Rajesh became interested in global health during medical school and public health training, when he was one of the co-founders of the Swasthya Community Health Partnership in Sringeri, south India. This partnership focused on gender-based health care in rural areas, and one of the central initiatives was to train nurses to provide health education, basic clinical care, and community empowerment. After completing his residency, he spent one year as the Team Leader of the Indiana University-Kenya Partnership in Eldoret, western Kenya. His responsibilities included teaching Kenyan medical and clinical officer students on both inpatient wards and outpatient clinics. In addition, he was a co-investigator of a research project that evaluated the effectiveness of community care extenders in providing HIV care in rural western Kenya. Subsequently, as a cardiology fellow and now as a junior faculty member at Icahn School of Medicine at Mount Sinai, he has been involved in a variety of global cardiology research initiatives. Rajesh’s research interest is in implementation research as applied to cardiovascular disease in low-resource settings. In Kenya, he is involved with the following projects: evaluation of the feasibility and effectiveness of nurse-based management of hypertension in rural western Kenya, and evaluation of novel strategies to optimize linkage and retention to a hypertension management program in rural western Kenya. He is also a co-investigator of the Grenada Heart Project, the first phase of which was a nation-wide survey of cardiovascular risk factors in Grenada. The second phase will involve an impact evaluation of a community-based program focusing on primary prevention of cardiovascular disease. Rajesh has also been a co-investigator on the Si Colombia project, which evaluates the impact of a cardiovascular health promotion program on preschool-aged children in Bogota, Colombia. Through these experiences, he has accrued expertise in working in resource-poor settings in low- and middle-income countries, pursuing activities in capacity building, service delivery, and research.
Zhi-Cheng is the new elected Union Scholar Distinguished Professor by Pekin Union Medical College, he is the Professor of Cardiology and Vascular Medicine, and the Chief of the Thrombosis and Vascular Medicine Center at the National Center for Cardiovascular disease, Fu Wai Hospital, State Key Lab of Cardiovascular disease, Pekin Union Medical College & Chinese Academy of Medical Science, Beijing, China. He also chaired the National Referral Center for Thrombosis and pulmonary vascular Disease of China. Zhi-Cheng obtained his medical degree in 1998 from Peking Union Medical College, Beijing, China, before participating in postdoctoral training at the Department of Pulmonary Disease and Intensive Care Unit at Hospital Antoine Béclère and the National Center of Pulmonary Vascular Diseases in Paris-Sud Université, Clamart, France.
Zhi-Cheng is the President of the Beijing Society of Thrombosis and Haemostasis, and the Vice President of the 9th Youth Committee of Chinese Society of Cardiology, he has participated in more than 30 global clinical trials on Cardiology. Among his many awards, he received the Best Poster Award of ESC 2013, National Ministry of Education of China’s ‘Outstanding Scholarship of New Century’ in 2011, the ‘Outstanding and Leading Scholarship’ from the Shanghai Government in 2011 and the Young Investigator Award of the ESC 2010. He has published more than 170 peer-reviewed academic papers in NEJM, LANCET, Circulation, AJRCCM, CHEST, ERJ, Cardiovascular Research and many international and Chinese academic journals, and is the Associate Editor of Annals of the American Thoracic Society. He is a member of the editorial board of the European Respiratory Journal, European Respiratory Review, the Chinese Medicine Journal (English version) and the China Journal of Cardiology.
During the pilot phase, the specific aims were:
An estimated 17 million people die from cardiovascular diseases (CVD) every year. Beta-blockers, angiotensin-converting enzyme (ACE-inhibitors), statins, and aspirin, have been proven to reduce mortality and recurrent cardiovascular events after a myocardial infarction (MI) or a stroke. These medications are widely recommended for the management of patients with CVD and their risk factors, yet their use is not optimal. Data from the Prospective Urban Rural Epidemiology (PURE) study involving 17 high, middle, and low-income countries reported that among CVD patients in the community several years after a stroke or those with coronary artery disease, only 25% were using antiplatelet drugs, 17% Beta Blockers, 20% ACE inhibitor or ARB, and 15% were using statins. This is worse in low and middle-income countries than in high-income countries.
One of the targets of the Global Action Plan (GAP) proposed by the World Health Organization (WHO) is an 80% availability of affordable basic technologies and essential medications to combat non-communicable diseases. Providing access to affordable essential medications in developing countries is also a target of the Millennium Development Goals (MDG). While access is necessary for medication use, it is not sufficient. Barriers to the use of medicines include patient-, provider-, and health system-level factors, as has been documented in the case of hypertension. Health system barriers include price, availability, and affordability of medicines. The health system can be adversely influenced by a lack of transparency in the procurement process, supply chain, and ultimate purchase of medications by patients. Pricing variability is evident across countries and within countries. In addition, counterfeit medications have been reported in high-income countries, as well as low- and middle-income countries. Our WikiMeds intervention, therefore, aims to increase transparency in medicine governance and thereby increase the use of quality medicines among people with CVD.
It is expected that WikiMeds will provide patients with information regarding the availability and effectiveness of generic medications recommended for the secondary prevention of CVD, locations to buy these medications at a cheaper cost, and the importance of using these medications. Informed patients will ask their providers to prescribe the medications indicated for their condition. With improved information regarding price, quality, and availability, patients will also ask for generic medications at lower prices. From the price and quality information on WikiMeds, patients will be able to identify pharmacies that sell these medications at a lower cost and will be able to identify lower quality medications. Patients will provide feedback to the WikiMeds platform regarding prices and quality of medications they purchase from the pharmacies, which will then use crowdsourcing technology to magnify and consolidate patients’ reviews/feedback, with the aim of making these issues known to a large public audience and, ultimately, the administrators of the health system who then have the power and obligation to enact changes at the health system level.
The increased demand for better quality generic medications at a lower price will likely translate into private pharmacies lowering their prices and increasing the availability of high-quality generic medications at lower prices. This will also apply pressure on the public sector to improve their procurement strategies of generic medications and negotiate lower prices. This pressure might even force the public sector to lower taxes and mark ups of medications. This framework assumes that providing patients with this information and empowering them to make choices will translate in more available and more affordable medications. It will also improve provider prescription practices with the overall aim of increasing the use of secondary prevention medications.