Current situation of chronic disease management at home and abroad and exploration of MTM model

In recent years, the explosive growth of chronic non infectious diseases (chronic diseases) has led to challenges in the management and treatment of patients with multiple chronic diseases The purpose of this paper is to explore the feasibility of MTM services in China by understanding the current situation and management of chronic diseases in China and the United States Medical therapy management (MTM) is a kind of medical treatment management service provided by professional pharmacists in the United States in the 1990s The purpose of MTM management is to help patients better understand their physical condition and medication, so as to improve their quality of life services The service content includes improving patients' cognition of their own diseases, popularizing the rules of drug use, ensuring the correctness of drug use, reducing drug waste, comprehensive cognition of adverse reactions and response plans for adverse reactions In addition, the comprehensiveness of MTM is ensured from five steps: drug treatment review, personal medication record, drug-related intervention plan, treatment record, treatment follow-up and so on According to the World Health Organization (WTO), chronic diseases take the lives of about 38 million people every year According to the World Economic Forum (WEF), in the next 10 years, the global chronic diseases will bring 47 trillion economic shocks （1） Chronic disease status and management model in the United States 1 Current situation of chronic diseases In the United States, six out of every ten adults have chronic diseases Chronic diseases such as heart disease, cancer and diabetes are the main causes of death and disability in the United States They drive $3.3 trillion a year in healthcare spending in the United States According to data from the Centers for Disease Control and Prevention (CDC), about 1.7 million Americans die of chronic diseases every year In fact, today, one quarter of American adults have two or more chronic diseases, and more than half of the elderly have more than three chronic diseases With the increase of age, the incidence of these types of comorbidities may also greatly increase According to the current population statistics of the United States, from now on to 2029, about 10000 Americans enter the 65 year old people's level every day Therefore, the total number of patients with complications will only increase It is reported that chronic diseases account for about 75% of the total medical expenditure; in terms of public insurance, the medical expenses of chronic diseases account for more than 90% and medical subsidies account for more than 80% Therefore, the management and prevention of chronic diseases is an important goal of American society To provide citizens with better health care and improve their overall quality of life 2 Chronic disease management In the United States, MTM management mode is adopted, and pharmacists will review all medication records of patients during drug treatment review, including prescription drugs, over-the-counter drugs, health care products and nutrients The pharmacist judges whether the patient has taken repeated, excessive or complementary drugs by understanding the personal medication record So as to ensure drug compliance This service is particularly important for the elderly, people with a variety of chronic diseases, and patients taking a variety of drugs Since 2014, the U.S medical insurance and Medicaid service center has included MTM services in part D of medical insurance, greatly increasing the scope of services available This service is free for all buyers of Part D insurance who meet the three criteria Participants are required to have at least two chronic diseases and use a variety of drugs covered by Part D insurance at the same time, and the annual cost of these drugs at their own expense is expected to exceed a certain price (US $3967 in 2018 and US $4044 in 2019) （2） Current situation and pain points of chronic diseases in China According to a joint study by the China Center for Disease Control and prevention and the Institute of neonatal diseases, the change of life style caused by the improvement of economic conditions has brought a "watershed" of China's health status to a large extent Chronic diseases have replaced infectious diseases as the key cause of early death of 1.4 billion people in China Among them, cardiovascular disease, stroke, lung cancer and liver cancer have replaced the diseases of lower respiratory tract and newborn, and become more life-threatening diseases 1 The incidence of chronic diseases is increasing and the burden of diseases is increasing The reasons for this change can not be separated from rapid urbanization, high salt and fat diet, long sitting and less exercise, air pollution and other aspects Although the progress of health and medical insurance has reduced the mortality rate of infectious "fast diseases", such as pneumonia, diarrhea, influenza and neonatal diseases, the bad life routine has quietly brought chronic diseases to the table Since 2000, the incidence rate of diabetes has become more rapid due to the change of lifestyle The national diabetes prevalence increased by 50%, from 4206 in 2000 to 6336 in 2017 According to statistics, about 6.3% of China's population has diabetes at present That's about 90 million people It is worth mentioning that in Taiwan, more than one in ten people suffer from diabetes Zhou maigeng, deputy director of chronic disease center of China CDC, once gave a speech at the 2018 Conference on chronic diseases and information: "at present, the epidemic trend of chronic diseases in China is very severe, and the proportion of chronic diseases in the death cause spectrum is 86.6%, and the proportion of chronic diseases in the disease spectrum is 70% With the change of the whole life style, the aging population will further increase the burden of chronic diseases " He pointed out that the construction of healthy China mainly needs chronic disease prevention and control The state has also put forward the strategy of chronic disease management, which focuses on prevention and combines prevention and control, so the importance of chronic disease prevention and control is self-evident 2 The demand for licensed pharmacists in China is urgent As of 2018, China has conducted more than 20 national unified examinations for licensed pharmacists According to the data of licensed pharmacists qualification certification center of the State Drug Administration, up to now, the registered number of licensed pharmacists in China is 495565, an increase of 6180 on a month on month basis The number of licensed pharmacists per 10000 population is 3.6 Among them, 89.9% were registered in drug retail enterprises, and only 33945, 3379, 11675 and 334 licensed pharmacists were registered in drug wholesale enterprises, drug manufacturing enterprises, medical institutions and other fields This data shows that most pharmacists are only limited to drug retail enterprises after passing the qualification certificate At present, there is still a huge gap in licensed pharmacists in China Although the passing rate is increasing year by year, the number of people who consult and obtain the pharmacist qualification certificate is decreasing year by year In general, the passing rate of pharmacists in China is less than 20%, which indicates that the demand for licensed pharmacists in China is more urgent at present.