Domestic and international explorations in chronic disease prevention and control: from learning from European and American models to China's breakthrough in "guideline toolization"

Some patients overly rely on medication while neglecting the importance and necessity of lifestyle modifications. They fail to understand that without lifestyle changes as a foundation, no medication can be fully effective. This is particularly common among middle-aged and young adults in their prime working years, due to both objective and subjective reasons.

Many doctors tend to focus on acute-phase treatment while neglecting the prevention and control of high-risk factors and chronic conditions. Some primary care physicians are unaware that medication is highly effective in controlling risk factors for preventing cardiovascular and cerebrovascular diseases, even surpassing interventional and other specialized treatments. Comprehensive prevention and control is the fundamental way to reduce the incidence, disability, and mortality rates of cardiovascular and cerebrovascular diseases. Currently, the cardiovascular and cerebrovascular disease management systems (software and models) used in medical institutions remain at the stage of general data collection and record management. They cannot guide or assist medical staff in the standardized, individualized comprehensive prevention, education, and management of large populations according to guidelines, resulting in a disproportionate investment of human, material, and financial resources in management and the clinical effectiveness of cardiovascular and cerebrovascular disease prevention and control.

Current public health education severely lacks popular science interpretation, individualized education, and guidance on the national guidelines for the prevention and control of hypertension, hyperlipidemia, and diabetes. Because of the complexity and specificity of the prevention and treatment of hypertension, hyperlipidemia, and diabetes, patients often find treatment difficult to understand, especially the blurred lines between normal values ​​for blood pressure, blood sugar, blood lipids, and obesity. Their "normal values" or "treatment goals" can only be determined after comprehensive risk stratification based on the patient's condition. This process of developing treatment goals and plans based on comprehensive risk stratification is an indispensable and crucial link in the modern prevention and treatment of hypertension, hyperlipidemia, and diabetes, determining the long-term effectiveness of prevention and treatment and forming the basis for effectively preventing myocardial infarction, stroke, and death. The lack of individualized education and guidance is one of the most fundamental reasons why the prevention and treatment of hypertension, hyperlipidemia, and diabetes falls far short of ideal levels.

European and American countries have done a great deal of work on patient health education. They have made numerous attempts to promote guidelines and improve the health education level of the general public. Among the most representative and authoritative works are: the "Go with the Guidelines" (GWTG) standard template system recommended by the American Heart Association; the "Prevention and Education Professional Action Group" (EUROACTION) of eight European countries; and the comprehensive risk assessment system for cardiovascular and cerebrovascular diseases. While these models have promoted the implementation of guidelines, their promotion in China faces considerable difficulties. For example, China has hundreds of millions of patients, and analyzing each one by a professional team would be an enormous undertaking, presenting significant challenges in terms of both the number of professionals and funding.

China has done a great deal of work in the prevention, management, and health education of hypertension, hyperlipidemia, and diabetes, particularly in evidence-based medicine research, the development and promotion of prevention guidelines, and public health education. Representative examples include the "China Adult Cholesterol Education Program," the Chinese Cardiovascular Disease Risk Assessment System, and the National Hypertension Community Standardized Management Project. However, from the perspective of comprehensive prevention, management, and health education for hypertension, hyperlipidemia, and diabetes, there is still room for improvement in the efficiency of promotion and training, the application of guidelines, and the level and efficiency of individualized health education and guidance based on guidelines.

As discussed earlier, the most prominent challenge is how to conduct standardized, individualized, rational, and efficient comprehensive prevention, management, health education, and health education for a large population based on relevant guidelines. The Expert Committee on the Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases believes that it is essential to conduct instrumental research on guidelines. To this end, after two and a half years, the research team, based on more than 10 domestic and international guidelines related to cardiovascular and cerebrovascular diseases and combined with information technology, created a brand-new and increasingly sophisticated guideline implementation tool system—the "Integrated Implementation System for Cardiovascular and Cerebrovascular Disease-Related Guidelines." With the system's assistance, clinicians can collect key data according to the guidelines, analyze, assess, and stratify cardiovascular and cerebrovascular diseases and their risk factors, and seamlessly complete all the major stages and tasks of integrated guideline implementation.