Decision 3756/QD-BYT in 2018 on guiding activities for prevention, early detection, diagnosis, treatment and management of a number of common non-communicable diseases for grassroots health care facilities issued by the Ministry of Health

DECISION

PROMULGATING GUIDELINES ON PREVENTION, EARLY DETECTION, DIAGNOSIS, TREATMENT AND MANAGEMENT OF COMMON NON-COMMUNICABLE DISEASES FOR LOCAL HEALTH FACILITIES

MINISTER OF HEALTH

Pursuant to Decree No.75/2017/ND-CP dated June 20, 2017 of the Government on functions, duties, rights and organizational structure of the Ministry of Health; 

Pursuant to Decision No.376/QD-TTg dated March 20, 2015 of the Prime Minister approving national strategy for preventing and fighting against cancers, cardiovascular diseases, diabetes, chronic obstructive pulmonary diseases, asthma and other non-communicable diseases during 2015-2025;

Consider the request of Director General of General Department of Preventive Medicine.

HEREBY DECIDE:

Article 1. Guidelines on prevention, early detection, diagnosis, treatment and management of common non-communicable diseases provided for local health facilities are issued together with this Decision.

Article 2. The Director General of General Department of Preventive Medicine shall take responsibility to cooperate with relevant entities in giving instructions for application of these guidelines and carrying out inspection of such application nationwide.

Article 3. This Decision comes into force from the day on which it is signed for promulgation. Should any reference document provided in the guidelines issued thereto be amended or replaced, the amended and replaced documents will prevail.

Article 4. Chief of the Ministry Office, Chief Ministry Inspectorate, Directors General, Directors of Departments affiliated to the Ministry of Health, Directors of Hygiene and Epidemiology Institutes, Director of Pasteur Institute, Directors of medical facilities affiliated to the Ministry of Health, Director of Health Department, Directors of Medical departments affiliated to relevant ministries and Directors of relevant entities shall take responsibility to implement this Decision.

GUIDELINES

ON PREVENTION, EARLY DETECTION, DIAGNOSIS, TREATMENT AND MANAGEMENT OF COMMON NON-COMMUNICABLE DISEASES PROVIDED FOR LOCAL HEALTH FACILITIES
(Issued together with Decision No.3756/QD-BYT dated June 21, 2018)

I. SCOPE AND REGULATED ENTITIES

1. Regulated entities

1.1. Medical officers include:

a) Medical officers in villages and hamlets in charge of initial healthcare and medical officers in neighbors according to Circular No.07/2013/TT-BYT dated March 8, 2013 of the Minister of Finance on standards, functions and duties of village medical officers

b) Medical officers working in agencies, organizations, schools, industrial zones and production facilities without medical examination and treatment establishment as per Law No.40/2009/QH12 on Medical examination and treatment

1.2. Commune-level health facilities include:

a) Medical aid stations of communes

b) Internal medical aid stations of organizations

c) Family clinics

1.3. Health facilities of districts, provincial cities and cities affiliated to centrally-affiliated cities (hereinafter referred to as “district-level health facilities”) include:

a) Medical centers of districts regulated by Circular No.37/2016/TT-BYT dated October 25, 2016 of the Minister of Health

b) Medical centers of districts regulated by Circular No.26/2005/TT-BYT dated September 9, 2005 of the Minister of Health

c) Classed III, IV and unclassed hospitals, infirmaries affiliated to provincial police authorities

d) Polyclinics and specialist clinics

2. Scope

2.1. Guidelines for prevention, early detection, diagnosis, treatment and management of common non-communicable diseases (hereinafter referred to as “NCDs”) for local health facilities

2.2. Certain common NCDs herein including hypertension, type 2 diabetes, asthma, chronic obstructive pulmonary diseases (hereinafter referred to as “COPD”), schizophrenia, epilepsy, depression, anxiety disorder, mental disorders by alcohol abuse, breast cancer, cervical cancer, oral cancer, lung cancer, prostate cancer and colorectal cancer

2.3. Criteria applied to medical aid stations performing prevention, management and treatment of NCDs (Appendix 2)

II. GUIDELINES ON PREVENTION, EARLY DETECTION AND MANAGEMENT OF CERTAIN COMMON NCDs PROVIDED FOR MEDICAL OFFICERS

1. Prevention of certain common NCDs

1.1. Health education communication

a) Integrate health education and communication about prevention of a common NCD in meetings, community events organized by the government, agencies, entities or schools

b) Make visits to households to propagandize, give instruction and advice to people about prevention and early detection of NCDs

c) Provide people with data on communication about prevention, early detection and management of certain common NCDs

d) Introduce websites such as suckhoetoandan.vn, vncdc.gov.vn, kcb.vn, huyetap.vn, benhviennoitiettrunguong.com.vn, benhphoitacnghen.vn, benhvienk.vn, bttttw1.gov.vn, nihe.org.vn, iph.org.vn, tihe.org.vn, Pasteur-nhatrang.org.vn, telephone switchboard for smoking cessation (18006606 or 18001214) to people, encourage them to listen to radio at 98.9 MHz and watch health programs broadcasted on VTV2, VTV3 O2TV channels and other channels for the purpose of accelerating knowledge of health  

1.2. Guidelines on changes in lifestyle behaviors and health improvement

a) Instruct people to have a healthy diet, reduce sodium, sugar and saturated fat intake, increase fruit and vegetable intake and enhance physical activity

b) Instruct smokers, people diagnosed with alcohol dependence, people having unbalanced diet or lacking physical activity to change their behaviors and live a healthy lifestyle

c) Encourage people to participate in health improvement programs in community, workplace or education environment for the purpose of preventing certain common NCDs

d) Give professional advice to the head of village, neighborhood, agency, organization, school, industrial zone and production facility that run health improvement models, create a working and learning environment without tobacco smoke and alcohol abuse for balanced diet assurance and increased physical activity

dd) Instruct smokers to contact the telephone switchboard for smoking cessation at 18006606 or 18001214, introduce medical facilities which provide advice on smoking cessation, alcohol withdrawal and instruction for healthy diet to people

2. Early detection of people vulnerable to common NCDs

a) Instruct people to self-assess their vulnerability to common NCDs according to the table posted on the website at https://suckhoetoandan.vn for timely examination and detection

b) Provide screening for early detection of certain common NCDs for people at the age of 40 years and older according to Appendix 1A and 1B issued thereto, any person with risk factors or signs of NCDs is recommended to go to medical facilities for examination and early diagnosis

c) Instruct people to take medical examination, periodic health examination and screening for early detection of certain common NCDs

d) Cooperate with upper medical facilities in carrying out medical examination for screening and early detection of people with NCDs in community, agencies, entities, schools, industrial zones or production and business facilities

3. Management of people with common NCDs

a) Update the list of NCD patients to manage and keep a watch on people with common NCDs in the area under management who are transferred by medical facilities of communes or upper medical facilities

b) Give instruction and advice to patients and their family for them to change their lifestyle behaviors, follow the treatment procedure, have a healthy diet, undergo care and rehabilitation and take periodic follow-up examination under the guidance of the medical facilities

c) Monitor the disease development, provide initial treatment and recommend patients to go to medical facilities for timely examination and treatment

d) Send monthly reports on the patient list and disease development of patients under management to medical facilities of communes

III. GUIDELINES ON PREVENTION, EARLY DETECTION, DIAGNOSIS, TREATMENT AND MANAGEMENT OF CERTAIN COMMON NCDs PROVIDED FOR MEDICAL FACILITIES OF COMMUNES

1. Prevention of certain common NCDs

1.1. Health education communication

a) Provide news and articles or provide information through radio network of communes, agencies, entities, schools, industrial zones, production and business facilities for communication purpose to improve knowledge on prevention of certain common NCDs

b) Establish communication departments or communication section in medical facilities in order for the patients and their family to get access to information concerning common NCDs

a) Integrate health education and communication about NCDs in conferences, meetings, community events organized by agencies, entities, schools, industrial zones, production and business facilities or the community

d) Cooperate with relevant entities in organizing communication programs on annual health days such as World Cancer Day (February 04), World Health Day (April 07), World Asthma Day (the first Tuesday of May), World Hypertension Day (May 17), World No Tobacco Day (May 31), World COPD Day (the Wednesday of the third week of November), World Heart Day (September 30), World Mental Health Day (October 10), World Stroke Day (October 29) and World Diabetes Day (November 14) in order to build social awareness about common NCDs

dd) Instruct and assist the medical officers in launching communication programs in community, agencies, entities, schools, industrial zones and production and business facilities

1.2. Creating a favorable environment for changes in lifestyle behaviors and health improvement

a) Recommend the head of community, agency, entity, school, industrial zone, production and business facility to establish health improvement models such as health improvement schools, health culture villages, create a working and learning environment without tobacco smoke and alcohol abuse for healthy diet assurance and increased physical activity

b) Provide professional assistance for health improvement models in community, agencies, entities, schools, industrial zones and production and business facilities

1.3. Prevention of certain common NCDs by specific vaccines and biologics

a) Maintain the rate of children fully vaccinated against Hepatitis B which leads to liver cancer

b) Provide HPV vaccine against cervical cancer, vaccine against respiratory infection for COPD prevention and other specific vaccines and biologics licensed for prevention of certain common NCDs as regulated by the Ministry of Health

2. Diagnosis, treatment and management of certain common NCDs

Medical facilities of communes shall give diagnosis, treatment, first aid and advice to people with certain common NCDs under the guidance of the Ministry of Health within the extent of the license for practicing medical examination and treatment granted to such medical facility. To be specific:

a) With regard to hypertension:

- Carry out medical examination and blood pressure measurement for hypertension diagnosis according to Decision No.2919/QD-BYT dated August 06, 2014 of the Ministry of Health on professional guidelines for medical examination and treatment provided by medical aid stations of communes.  Referral is required if the case is beyond technical competency of the medical facility.

- Provide outpatient treatment for patients with hypertension according to Decision No.2919/QD-BYT dated August 06, 2014 of the Minister of Health issuing professional guidelines on medical examination and treatment by medical aid stations of communes or treatment under the guidance of upper medical facilities  Make prescription according to Circular No.52/2017/TT-BYT dated December 29, 2017 of the Minister of Health providing for prescription of modern drugs and biological in outpatient treatment (hereinafter referred to as “Circular No.52/2017/TT-BYT).  Referral is required if the case is beyond the technical competency of the medical facility.

- Monitor patient’s blood pressure and complications, and provide stroke rehabilitation service and first aid for an acute hypertensive crisis

- Give advice to patients or their family on changes in lifestyle behaviors, conformity with the treatment procedure, healthy diet, care, rehabilitation and periodic follow-up examination depending on the disease condition

b) With regard to type 2 diabetes:

- Carry out medical examination and capillary blood glucose monitoring for the purpose of detecting the person with type 2 diabetes and refer such person to upper medical facilities for medical diagnosis according to Decision No.3319/QD-BYT dated July 19, 2017 of the Minister of Health promulgating professional guidelines for diagnosis and treatment of type 2 diabetes and Decision No.3798/QD-BYT dated August 21, 2017 of the Minister of Health on professional procedures for examination and treatment of type 2 diabetes

- Provide outpatient treatment for people with type 2 diabetes under the guidance of upper medical facilities  Prescription is subject to Circular No.52/2017/TT-BYT and referral is required if the case is beyond the technical competence of the medical facility.

- Monitor patient’s blood glucose and complications caused by diabetes, and provide rehabilitation after complications and first aid for hypoglycemia

- Give advice to patients or their family on changes in lifestyle behaviors, conformity with the treatment procedure, healthy diet, care, rehabilitation and periodic follow-up examination depending on the disease condition

c) With regard to asthma:

- Carry out medical examination and peak expiratory flow measurement for the purpose of detecting the person with asthma signs and refer such person to upper medical facilities for diagnosis according to Decision No.3942/QD-BYT dated October 02, 2014 of the Minister of Health promulgating professional guidelines for diagnosis and treatment of allergy – clinical immunology

- Provide outpatient treatment for people with asthma under the guidance of upper medical facilities Prescription is subject to Circular No.52/2017/TT-BYT and referral is required if the case is beyond the technical competence of the medical facility.

- Keep a watch on the disease development and provide first aid for severe asthma attack

- Give advice to patients or their family on asthma detection methods, assurance of hygiene in residence place and workplace for risk factor elimination, diet for prevention of obesity and underweight and periodic follow-up examination as regulated

d) With regard to COPD:

- Carry out examination and detection of the person with risk factors or symptoms of COPD and refer such person to upper medical facilities for diagnosis according to Decision No.2866/QD-BYT dated July 08, 2015 of the Minister of Health promulgating professional guidelines for COPD diagnosis and treatment

- Provide outpatient treatment for people with COPD under the guidance of upper medical facilities  

Prescription is subject to Circular No.52/2017/TT-BYT and referral is required if the case is beyond the technical competence of the medical facility.

- Keep a watch on the disease development and provide rehabilitation and first aid for acute shortness of breath

- Give advice and assistance to patients or their family about smoking cessation, prevention of exposure to secondhand tobacco smoke, dust, coal smoke and toxic gases, conformity to treatment regime, physical exercise and follow-up examination as regulated

dd) With regard to cervical cancer, breast cancer, oral cancer and colorectal cancer:

- Carry out medical examination and detection of people with cancer sign according to Decision No.3338/QD-BYT dated September 09, 2013 of the Ministry of Health providing guidelines on medical procedures for professional medical examination and treatment of oncology and provide referral system for medical diagnosis

- Provide assistance in patient care in community under the guidance of upper medical facilities

e) With regard to other common NCDs:

- Carry out medical examination and detection of people with NCD signs and provide referral system for medical diagnosis

- Provide assistance in patient care in community under the guidance of upper medical facilities

3. Common NCD information management

a) Apply information technology in management of NCDs in medical facilities of communes as regulated by the Ministry of Health

b) Add all relevant information to personal health record of each patient in the area for monitoring and management

c) Monthly transfer the list of patients with NCDs to medical officers for continuing management in community

d) Periodically make consolidated reports on condition of detection, treatment, management, number of NCD patients and deaths by NCDs according to the form specified in Circular No.27/2014/TT-BYT dated April 18, 2014 of the Ministry of Health providing for medical report form system applied to medical facilities of provinces, districts and communes and according to other relevant instruction of the Ministry of Health

IV. GUIDELINES ON PREVENTION, EARLY DETECTION, DIAGNOSIS, TREATMENT AND MANAGEMENT OF CERTAIN COMMON NCDs PROVIDED FOR MEDICAL FACILITIES OF DISTRICTS

1. Prevention of certain common NCDs

1.1. Health education communication

a) Write articles or information through radio network of districts, communes, centrally-affiliated cities, agencies, entities, schools, industrial zones, production and business facilities for communication purpose to accelerate people’s knowledge on prevention of certain common NCDs

b) Establish communication departments or communication section in medical examination and treatment departments in order for the patients and their family to get access to information concerning certain common NCDs

a) Integrate health education and communication in conferences and meetings organized by agencies, entities or schools in districts and provincial cities and special events for patients and their family

d) Take initiative in organizing communication campaigns in districts and provincial cities on annual health days such as World Cancer Day (February 04), World Health Day (April 07), World Asthma Day (the first Tuesday of May), World Hypertension Day (May 17), World No Tobacco Day (May 31), World COPD Day (the Wednesday of the third week of November), World Heart Day (September 30), World Mental Health Day (October 10), World Stroke Day (October 29) and World Diabetes Day (November 14) in order to build social awareness about common NCDs

dd) Provide professional guidelines and assistance for medical facilities of communes in launching health education and communication programs for prevention of common NCDs

1.2. Creating a favorable environment for changes in lifestyle behaviors and health improvement

a) Cooperate with the head of company, agency, entity, school, industrial zone, production and business facility in districts in establishing health improvement models such as health improvement schools, health culture villages, creating a working and learning environment without secondhand smoke and alcohol abuse for healthy diet assurance and increased physical activity

b) Provide professional assistance in launching health improvement programs in agencies, entities, schools, industrial zones and production and business facilities

c) Instruct medical facilities of communes to create a favorable environment for changes in lifestyle behaviors and health improvement

1.3. Prevention of certain common NCDs by specific vaccines and biologics

a) Provide HPV vaccine against cervical cancer, vaccine against respiratory infection for COPD prevention and other specific vaccines and biologics licensed for prevention of certain common NCDs as regulated by the Ministry of Health

b) Instruct medical facilities of communes to carry out NCD prevention works by specific vaccines and biological

2. Diagnosis, treatment and management of certain common NCDs

Medical facilities of districts shall give diagnosis, treatment, emergency response and advice to people with certain common NCDs under the guidance of the Ministry of Health within the extent of the license for practicing medical examination and treatment granted to such medical facility. To be specific:

a) With regard to hypertension:

- Give diagnosis, treatment, first aid for emergency and advice to patients with hypertension according to Decision No.3192/QD-BYT dated August 31, 2010 of the Minister of Health providing for guidelines on hypertension diagnosis and treatment  

Referral is required for diagnosis, treatment and emergency response if the case is beyond technical competence of such medical facility.

- Transfer patients to medical facilities of communes for continuing management and treatment after they are diagnosed and treated through emergency or their condition has been improved

b) With regard to type 2 diabetes:

- Give diagnosis, treatment, first aid and advice to patients with type 2 diabetes according to Decision No.3319/QD-BYT dated July 19, 2017 of the Minister of Health promulgating professional guidelines for diagnosis and treatment of type 2 diabetes and Decision No.3798/QD-BYT dated August 21, 2017 of the Minister of Health on professional procedures for examination and treatment of type 2diabetes. Referral is required for diagnosis, treatment and emergency response if the case is beyond the technical competence of the medical facility.

- Transfer patients to medical facilities of communes for continuing management and treatment after they are diagnosed and treated through emergency or their condition has been improved

c) With regard to asthma:

- Give diagnosis, treatment, first aid and advice to patients with asthma according to Decision No.3942/QD-BYT dated October 02, 2014 of the Minister of Health promulgating professional guidelines for diagnosis and treatment of allergy – clinical immunology  

Referral is required for diagnosis, treatment and emergency response if the case is beyond the technical competence of such medical facility.

- Transfer patients to medical facilities of communes for continuing management and treatment after they are diagnosed and treated through emergency or their condition has been improved

d) With regard to COPD:

- Give diagnosis, treatment, first aid and advice to patients with COPD according to Decision No.2866/QD-BYT dated July 08, 2015 of the Minister of Health promulgating professional guidelines for COPD diagnosis and treatment  

Referral is required for diagnosis, treatment and emergency response if the case is beyond the technical competence of such medical facility.

- Transfer patients to medical facilities of communes for continuing management and treatment after they are diagnosed and treated through emergency or their condition has been improved

dd) With regard to cervical cancer, breast cancer, oral cancer and colorectal cancer: Carry out medical examination according to Decision No.3338/QD-BYT dated September 09, 2013 of the Ministry of Health providing guidelines on medical procedures for professional examination and treatment of oncology and provide referral system for medical diagnosis

e) With regard to other common NCDs: Give diagnosis, treatment, emergency response, advice and referral under the guidance of the Ministry of Health

3. Common NCD information management

a) Apply information technology in NCD management as regulated by the Ministry of Health

b) Send monthly list of patients to medical facilities of communes and instruct these facilities to update information and manage patients with NCDs in community

c) Periodically or regularly make consolidated reports on condition of detection, treatment, management and number of NCD patients and deaths by NCDs according to the form specified in Circular No.27/2014/TT-BYT dated April 18, 2014 of the Ministry of Health providing for medical report form system applied to medical facilities of provinces, districts and communes and according to other relevant instruction of the Ministry of Health

V. IMPLEMENTATION

1. Department of Preventive Medicine shall:

a) cooperate with relevant entities in applying these guidelines nationwide

b) review and amend legislative documents and professional guidelines on prevention and management of certain common NCDs provided for local health facilities

c) take the lead in cooperation with professional institutes, central hospitals, universities, research institutes, and relevant international organizations in offering training courses for the purpose of increasing local authorities' capacity for prevention, early detection, diagnosis, treatment and management of common NCDs in local health facilities  

d) cooperate with relevant entities in organizing dissemination of knowledge through mass media and communication campaigns for policies on increased prevention, early detection, diagnosis, treatment and management of common NCDs carried out by local health facilities

dd) provide guidelines for running the key model and share experiences in prevention, early detection, diagnosis, treatment and management of common NCDs by local health facilities

e) take the lead in inspecting, supervising and reporting the prevention, early detection, diagnosis, treatment and management of common NCDs by local health facilities

2. Medical Service Administration shall:

a) direct and instruct medical examination and treatment facilities to apply these guidelines nationwide

b) review and amend legislative documents and professional guidelines on diagnosis and treatment of certain common NCDs provided for local health facilities

c) direct medical examination and treatment facilities to offer training courses for the purpose of increasing the medical officers’ technical competencies for diagnosis, treatment management and medical advice given to the patients

d) carry out inspection and supervision, give professional advice on diagnosis and treatment of common NCDs by local health facilities

3. Department of Communications and Reward shall:

b) review and amend documents, guidelines and communication documents on certain common NCDs provided for local health facilities

b) direct and instruct relevant entities and local authorities to offer training courses in prevention and control of certain common NCDs for medical officers working in local health facilities

c) provide guidelines and cooperate with relevant entities in establishing health models and health clubs, and give local health facilities instructions as to organization of forms of communication campaigns for preventing and fighting against certain common NCDs

4. Department of Health Insurance shall:

a) review and amend legislative documents and health insurance guiding documents for prevention, early detection, diagnosis, treatment and management of certain common NCDs in local health facilities

b) carry out inspection and supervision and provide assistance in complying with health insurance regulations applied to prevention, early detection, diagnosis, treatment and management of certain common NCDs by local health facilities

5.  Central Hygiene and Epidemiology Institute, Nha Trang Pasteur Institute, Central Highlands Hygiene and Epidemiology Institute, Ho Chi Minh City Public Health Institute and Occupational and Environmental Health Department affiliated to the Ministry of Health shall:

a) preside over and cooperate with relevant entities in carrying out necessary review, establishing and amending documents and guidelines on prevention, early detection, treatment and management of certain common NCDs provided for local health facilities according to the field under control as assigned

a) preside over and cooperate with relevant entities in offering training courses for increasing the capacity for prevention, early detection and treatment of common NCDs of medical officers working in local health facilities in the area under management 

c) provide guidelines on prevention, early detection, treatment and management of common NCDs for local health facilities as decentralized and assigned according to the area under management

6. Central general and specialist hospitals shall:

a) preside over and cooperate with relevant entities in carrying out necessary review, establishing and amending documents and guidelines on prevention, early detection, diagnosis, treatment and management of certain common NCDs provided for local health facilities according to the field under control as assigned

a) preside over and cooperate with relevant entities in offering training courses in early detection, diagnosis, treatment and management of common NCDs for medical officers working in local health facilities in the field under control as assigned

c) provide guidelines on prevention, early detection, diagnosis, treatment and management of common NCDs for local health facilities as decentralized and assigned according to the area under management

d) transfer the patient to local health facilities for continuing management and treatment after giving diagnosis and treatment to such patient and verifying that the patient’s case is within technical competence of such local health facilities  

7. Health Department of provinces and centrally-affiliated cities shall:

a) provide guidelines for People's Committee of provinces and cities. To be specific:

- Include the task of NCD prevention and management in the task performed by the Steering Committee for people's healthcare of all levels

- Allocate resources to perform the task of NCD prevention, early detection, diagnosis, treatment and management in the area under management

- Instruct relevant departments and unions to cooperate with one another in preventing and fighting against NCD risk factors and improving people's health

b) instruct and urge entities in the area under management to comply with regulations herein and carry out inspection of such compliance

c) run the model of medical centers of districts according to Circular No.37/2016/TT-BYT dated October 25, 2016 of the Minister of Health on functions, duties, rights and organizational structure of medical centers of districts, provincial cities and cities affiliated to centrally-affiliated cities 

d) provide the basic package of health services applied to local health facilities according to Circular No.39/2017/TT-BYT dated October 18, 2017 of the Minister of Health on basic package of health services applied to local health facilities

dd) ensure necessary equipment for prevention, early detection, diagnosis, treatment and management of certain NCDs

e) assign the Centers for disease control/preventive health centers of provinces to take the lead in preparing plans and running activities for prevention, early, diagnosis, treatment and management of certain common NCDs in provincial local health facilities

8. Centers for disease control/ preventive health centers of provinces and cities shall:

a) preside over and cooperate with relevant entities in offering training courses in NCD prevention, diagnosis, treatment and management for medical officers working in local health facilities in the area

d) cooperate with relevant entities in organizing propaganda on mass media and communication campaigns for policies on increased the prevention, early detection, diagnosis, treatment and management of common NCDs by local health facilities

c) provide guidelines on prevention, diagnosis, treatment and management of common NCDs in the area

d) take the lead in inspecting, supervising and managing data, and reporting the prevention, early detection, diagnosis, treatment and management of common NCDs by local health facilities in the area

9. General and specialist hospitals of provinces and cities shall:

a) preside over and cooperate with relevant entities in offering training courses in diagnosis and treatment of common NCDs for medical officers working in local health facilities according to the field under control as assigned

d) transfer the patient to local health facilities for continuing management and treatment after giving diagnosis and treatment to such patient and verifying that the patient’s case is within the technical competence of such local health facilities 

c) provide guidelines on early detection, diagnosis and treatment of common NCDs according to the field under control as assigned

APPENDIX 1A

GUIDELINES FOR DETECTION OF PEOPLE WITH NCD RISK FACTORS (APPLIED TO PEOPLE AT THE AGE OF 40 YEARS AND OLDER)

I. Detection of people with risk factors

1. Hypertension and cardiovascular risk

- Age over 55 years for male and over 65 years for female

- Tobacco use

- Physical activity less than 30 minutes/day and less than 5 days/week (including physical exercise, sport, jogging and manual work)

- Daily sodium intake of more than 5 grams (1 teaspoon)

- Daily intake of less than 400 grams of fruit and vegetable

- Alcohol abuse

- Family history of cardiovascular disease at the age under 55 years for male and under 65 years for female

- Regular feeling of stress

- Overweight and obesity

- Diabetes diagnosis by medical facilities

-  Dyslipidemia diagnosis by medical facilities

2. Type 2 diabetes

- Age of 45 and older

- Overweight and obesity

- Hypertension diagnosis by medical facilities

- Family history of type 2 diabetes

- Dyslipidemia diagnosis by medical facilities

- Physical activity less than 30 minutes/day and less than 5 days/week (including physical exercise, sport, jogging and manual work)

- Tobacco use

- Women diagnosed with olycystic ovary syndrome or diabetes during pregnancy

3. Asthma

- Past history of allergic diseases (e.g. eczema, allergic rhinitis, hives, angioedema, etc)

- Family history of asthma or aforesaid allergic diseases

- Overweight and obesity

- Regular exposure to dust, fur, pollen, molds, certain drugs or chemicals

4. Chronic obstructive pulmonary diseases

- Uncontrolled asthmatic patients

- Tobacco use

- Regular exposure to dust or chemicals or polluted air by use of coal stoves, gas stoves or wood-burning stoves

- Experience of recurrent respiratory infections

5. Schizophrenia

- Family history of schizophrenia

- Complications experienced while in the womb or brain injury from birth

- Experience of high-stress family relationships

- Alcohol and drug abuse

6. Epilepsy

- Past history of traumatic brain injury or encephalitis

- Family history of epilepsy

- Alcohol and drug abuse

7. Other common mental illness

- Experience of bacterial diseases, brain injury or terminal diseases

- Experience of posttraumatic stress disorder or family and/or social conflicts

- Postpartum women

- Difficulties in life, experience of financial stress, work stress, school stress or exam stress

- Exposure to social-cultural conflicts in new place after moving or exposure to disasters, natural disasters or wars

- Alcohol and drug abuse or video game addition  

- Family history of mental illness

8. Certain cancers

- Age over 40 years  

- Tobacco use

- Physical activity less than 30 minutes/day and less than 5 days/week (including physical exercise, sport, walking and manual work)

- Alcohol abuse

- Family history of cancer

- Exposure to chemicals, dust, X-ray, radioactive, ultraviolet, radon, asbestos, arsenic, benzene, etc

Notes:

. For alcohol abuse: With regard to male: Intake of more than 2 330-ml bottles of beer (5%) or more than 2 330-ml cans of beer (5%) or more than 2 330-ml cups of beer or more than 2 100-ml cups of wine (13.5%) or more than 2 30-ml cup of spirits (40%); With regard to female: Intake of more than three thirds of a 330-ml bottle of beer (5%) or more than three thirds of a 330-ml can of beer (5%) or more than 1 330-ml cup of beer (5%) or more than 1 100-ml cup of wine (13.5%) or more than 1 30-ml cup of spirits (40%)

. For overweight and obesity: Carry out measurement for weight and height to calculate BMI (Body mass index) which is defined as a person's weight in kilogram divided by the square of such person's height in meter. A person shall be considered overweight if his/her BMI is from more than 25 to 30 and obese if the BMI is over 30 (according to WHO)

II. Handling

- Give advice to people with risk factors for them to change their lifestyle behaviors

- Take periodic health examination

APPENDIX 1B

GUIDELINES FOR DETECTION OF PEOPLE WITH SIGNS OF NCDs

I. Detection of people with signs of NCDs

1. Hypertension

Hypertension shall be diagnosed if:

Systolic pressure is between 130 and 139 mmHg and/or diastolic pressure is between 80 and 89 mmHg.

2. Diabetes

- Frequent urination

- Increased thirst

- Increase hunger

- Unexplained weight loss

3. Asthma

Cough or cough up with white and sticky mucus, chest tightness, wheezing, difficulty breathing (shortness of breath)  The aforesaid symptoms recurs and worsen at night or in the morning or during weather changes or exertion or exposure to smoke, dust, pollen, mold, cat and dog fur, chemicals or certain drugs 

4. Chronic obstructive pulmonary diseases

Chronic cough up mucus (cough up with white and sticky mucus in the early morning), increased difficulty breathing

5. Schizophrenia

Speech abnormalities, delusion of thought interference such as thought insertion or thought broadcasting, feeling of suspicion and irritability  

6. Epilepsy

- Movement disorder, behavioral or emotional disorder defined as a sudden, short-duration and formative attack (the previous one similar to the following)

- Experience of sudden spasticity, loss of consciousness, falling, convulsions and urinary incontinence

- Muscle shaking in some minutes without loss of consciousness

- Regular chopstick dropping during meal or pen dropping while writing

7. Depression

- Depressed mood, feeling of sadness and hopelessness

- Loss of interest in previously enjoyable activities or noticeable neglect of previous pleasures

- Feeling tiredness, inactivity and loss of interest in work

8. Anxiety disorder

- Feeling stress or anxiety

- Excessive worry about everything

9. Mental disorders caused by alcohol abuse

Mental disorder by alcohol abuse shall be diagnosed if the following symptoms are experienced after a heavy drinker stops or reduces his/her alcohol intake:

Shaking, insomnia, feeling stress, uneasiness, sweating, increased heart rate, headache, and loss of consciousness or convulsions

10. Certain cancers

- Persistent ulcers

- Prolonged cough, chest tightness but ineffective treatment

- Dyspepsia or dysphagia

- Change in bladder and bowel habits

- Tumors in breast or body

- Unusual enlarged lymph nodes

- Abnormal vaginal bleeding or discharge

- Tinnitus or diplopia

- Unexplained weight loss or anemia

II. Handling

- Recommend people with signs of NCDs to go to medical facilities for timely examination, detection and treatment

- Give advice about changes in lifestyle behaviors for disease prevention

APPENDIX 2

CRITERIA APPLIED TO MEDICAL AID STATIONS OF COMMUNES PERFORMING NCD PREVENTION, MANAGEMENT AND TREATMENT OF

I. NCD prevention

1. Launch projects on health education and communication about NCD prevention

2. Create a favorable environment for lifestyle behavior changes and health improvement of people

3. Early detect and give health advice to people with high risk factors of NCDs

II. NCD management and treatment

1. Provide medical examination and diagnosis, prepare outpatient medical records, make up prescription as regulated, keep regular watch on the disease development and give the patients advice about care and rehabilitation  

Fully add relevant information to the personal health record of the patient

2. Provide referral system and report the NCD patient information as regulated

3. Ensure necessary drugs and equipment for NCD management and treatment in accordance with regulations issued by the Ministry of Health

4. Apply information technology in NCD management by medical aid stations of communes as regulated by the Ministry of Health

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