Download scriining programs georgian experiance

Nino Kiknadze
Associated Professor of Family Medicine Department
Tbilisi State Medical University
Georgian Representative in EURACT
KIEV November 2016
SCREENING PROGRAMS IN
GEORGIA
Antenatal Screening for high risk pregnant women
Newborn Screening for hereditary disease
Hepatitis C Screening
Childhood Developmental Screening
Cancer Screening
CANCER SCREENING - HISTORY
 2006 y – Health and Social Affairs Department (HSAD) of the
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Tbilisi Municipality and UNFPA Georgia for Reproductive Tract
(RT) cancers prevention and early detection was launched in
Tbilisi.
2008 y -The project was redesigned to focus on breast and
cervical cancer screening for the targeted population in Tbilisi.
The NSC was selected to implement the project.
2009y – Replication of the project at the national level.
2011, the comprehensive cancer screening programme (breast,
cervical, colorectal cancer screening and prostate cancer risk
management) became available in Georgia through the national
programme under NCDC&PH (MoLHSA)
2014y – Pilot programme launched in one region - PHC
(Cervical cancer)
CANCER SCREENING PROGRAM
EB
SCREENING
PROGRAMS
CME
POPULATIO
N
BEHAVIOR
CHANGE
PHC ACTIVE
RECRUETE
MENT
Quality
Manageme
nt
UNFPA
MoHLSA–
NCDC-NSC
IT SYSTEM
Legislatio
n
CANCER SCREENING PROGRAM
Physical examination
BREAST CANCER
2008
MAMMOGRAPHY
Ultrasound
Biopsy + Cytology
CERVICAL CANCER
2008
PAP - Smear
COLORECTAL CANCER
2011
FOBT
Colposcopy
Biopsy
Colonoscopy
biopsy
PROSTATE CANCER
??? 2010
PSA
CANCER SCREENING 2010-2015
CANCER
BREAST
SCREENING
METHOD
CERVICAL
PROSTATE
COLORECTA
L
MAMMOGRA PAP-SMARE
PHY
PSA
FOBT
AGE RANGE
40 - 70
25- 60
50-70
50-70
INTERVAL
3y
3y
1y
1y
AVE. N
SCREENED
PER YAR
16180
16553
4268
1393
COVERAGE
14.70%
16.26%
3.40%
0.70%
SCREENING PROGRAMS - BUDGET
900,000.00
828,397.00
831,650.00
803,858.00
800,000.00
89%
701,563.00
79%
700,000.00
79%
79%
600,000.00
471,382.00
500,000.00
UNFPA
MoHLSA
400,000.00
76%
SUM
300,000.00
200,000.00
24%
21%
21%
21%
11%
100,000.00
1
2
3
4
5
CANCER SCREENING PROGRAM
POPULATION BEHAVIOR CHANGE
SCRINING PROGRAMS IN PHC - ACTIVE
RECRUETEMENT
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



PILOT PROGRAM IN ONE REGION OF GEORGIA
KAKHETI IORI
Village doctors will counsel women about cervical
screening and then take a Pap test.
The Pap test will be sent to the KIC for processing.
Screening results will be sent to the referring doctor
who will report them to the women and counsel those
having an abnormal result.
Refer for Further Evaluation
Recalls
SCREENING PROGRAM CME/CPD
SCREENING PROGRAM CME/CPD
Local and International CME courses for
 Radiologists, Morphologists, Gynecologists,
Mammologists
 Village doctors
 Program administration
 IT Staff
 Customer service staff
SCREENING PROGRAMS IT
 2011 - New Information management system for the
Screening Programme, developed through the UNFPA
The first module of the system – the patients’/clients’
visits registration
The second module of the system - management of
clinical information - allows managing electronically
all clinical information.
SCREENING PROGRAMS QUALITY
MANAGEMENT
 Unification of cytology results
 Unification of Radiological Interpretation (BIRADS)
 Development of indicators for each screening program
 Quality assessment system in each provider
SCREENING PROGRAM EFFECTS
Stage distribution of breast cancer cases detected after treatment; the National Screening
Programme, 2009
According 2006-2007 national statistical data, only ~ 33% of new incidents of cancers were
detected at I-II stages
1%
6%
3%
24%
9%
9%
STAGE I
STAGE IIa
STAGE IIb
STAGE IIIa
STAGE IIIb
STAGE IIIc
48%
STAGE IV
SCREENING PROGRAM EFFECTS
Abnormal PAP - smear distribution (%) (N=1701) Total N of Screened Women
9650 2013 NCC
3.40%
0.60%
0.60%
8.20%
36.90%
ASCUS
ASC-H
LSIL
HSIL
AGUS/AGC
47.90%
Nondiagnostic
Carcinoma
2.50%
FINANSIAL EFFECTS OF CANCER
SCREENING
“ounce of prevention is worth a pound of cure,”
AVIALLABLE STATISTICAL DATAS AND
PROGRAM COVERAGE ARE NOT INOUGH
FOR CALCULATE REAL FINANSIAL EFFECT
OF CURRENT SCREENING PROGRAMS, BUT -
Benjamin Franklin (1706 - 1790) one of the Founding Fathers of the US .