Palliative care in chronic illness

The authors need to move from prognostic paralysis to active total care for patients with progressive chronic illnesses in whom death may be approaching, reflecting a failure to think proactively and holistically about their care.

Abstract

many years' effort by health services in rural areas, only 5.4% of people with hypertension receive drug treatment and only 0.9% have their blood pressure effectively controlled. 7 11 Research evidence on the biological efficacy of these drugs is often universally generalisable.Guidelines are, however, value laden, have cost implications, and are not universally applicable; thus those developed for one population may not suit another.As well as the thresholds for initiating treatment, factors such as treatment targets, competing priorities for drugs, diagnostic testing, and frequency of follow-up all have cost implications.The treatment target is the level of blood pressure or cholesterol to achieve through treatment-the lower the target the more resources are required to achieve it.China should probably consider targets that differ from those for Western populations.Locally tailored treatment guidelines could further improve cost efficiency.For instance, antihypertensive drugs might be given precedence in China, particularly in the rural areas, over cholesterol lowering drugs because they are cheaper and also reduce the incidence of stroke.Stroke is common in China, and in some areas it is the leading cause of death.Each year 1.3 million people have a first stroke, four times the incidence of acute myocardial infarction. 12iven national differences in epidemiology, local needs, and affordability, developing countries such as China need to tailor their national policies for managing chronic conditions.If policies for other populations are used, adapting, rather than simply adopting, will bring greater benefits to patients.