GUYANA PROGRAM for ADVANCEMENT OF CARDIAC CARE (GPACC)
Background:
Cardiovascular diseases are the leading cause of death in most South American
and Caribbean countries, and Guyana is certainly no exception. However,
reliable information on the prevalence/classification of heart disease, essential to
national prevention and management policies, is lacking in Guyana. The Guyana
Echocardiography Education Program, started by Dr. Debra Isaac in 2012, with
donated equipment, volunteer medical specialists and technologist instructors.
Partial financial support of the Libin Cardiovascular Institute in Calgary has also
helped to further identify the high burden of cardiac disease in that country.
Cardiac care in the public health system of Guyana remains sub-optimal, with
very limited access to timely intervention and evidence-based management
strategies. For example, patients with acute myocardial infarction are not being
treated quickly with well-established treatments, which can save lives and reduce
disability. This is in part related to the lack of funding for timely access to the
cardiac catheterization laboratory at the Guyana Public Hospital Corporation
(GPHC).
Patients with serious acute heart conditions are not being cared for in dedicated
cardiac units or by healthcare providers with expertise in cardiac care. Patients
with more chronic heart disease are not identified early, are only treated once
their disease has progressed to end-stage, and are not followed regularly. The
opportunity for early treatment and intervention, which could significantly
decrease downstream healthcare costs, is being missed. There are too few
specialized doctors to see patients in a timely fashion, or follow the patients
adequately. Allied healthcare practitioners are not trained or utilized to provide
increased capacity in the system.
With too many patients, too few physicians, extremely limited support, and no
way to track patient care, adequate care cannot be provided. The rate of
morbidity, mortality, hospital admissions and re-admissions is very high.
Terms of Reference:
In partnership with the Georgetown Public Hospital Corporation (GPHC), the
Ministry of Health for Guyana (MOH), and the University of Calgary, GPACC will:
 Help to establish an acute cardiac care unit at the GPHC which will provide
evidence-based patient care.
 Introduce multidisciplinary chronic disease management teams
(pharmacists and nurses led by a physician) into the public health system,
with the initial focus being on heart failure management.
 Establish teaching programs for staff physicians, medical residents, and
medical students in Guyana, regarding the provision of evidence-based
cardiac care.
 Provide a reliable and inclusive electronic medical record to track patients
and provide accurate, up-to-date information, enhancing patient care,
tracking outcomes, and identifying areas for improvement.
 Develop and institute research programs to evaluate the impact of
educational reform and the development of patient care systems and
protocols.
Deliverables:
The Guyana Program for Advancement of Cardiac Care (GPACC) will provide:
1. education (on-site and remote] of medical, nursing, and respiratory
personnel.
2. expert advice and supervision for the construction and functioning of a
new up-to-date cardiac care unit.
3. provision of an electronic database
4. research:
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provision of dedicated clinician-researcher(s), supported by
GPACC (in conjunction with GPHC)
development and implementation of patient care protocols
development of research questions and formal research protocols
oversight and tracking of progress regarding patient care protocols
and research protocols (data gathering, analysis, presentation)
GPHC/MOH will provide:
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physical structure
up-to-date equipment
co-support of clinician-researcher
local staff:
o physicians (staff and trainees),
o nurses
o respiratory technologists
o non-medical support personnel
Timeline (initial):
Program initiation May - September 2015:
1.
2.
3.
4.
identify and contract with clinician-researchers
work with GPHC - new cardiac unit / chronic disease clinic development
develop educational curriculum for GPHC staff
develop patient care protocols for cardiac unit
5. develop research questions and protocols
o existing standards of care and outcomes at GPHC
o medical education provision around proposed programs
chronic disease management initiatives
o other related potential research initiatives
6. data gathering and analysis for ongoing research protocols in GPHC
echocardiography program, pediatric cardiology, and Heart Failure Clinic
GPACC Funds:
GPACC will be directed and administered by Dr. Debra Isaac and Dr. Wayne
Warnica under the umbrella of Global Health and International Partnerships,
Cumming School of Medicine at the University of Calgary. It is anticipated that it
will be funded by up to $250,000 to be expended over 4 years.
Expenditures will relate to the following categories:
1) clinician-researcher stipend(s)
2) program partner travel between Guyana and Calgary
3) electronic database development and hardware
4) research-related equipment for Guyana
5) educational resources
Conclusions:
It is anticipated that the Guyana Program to Advance Cardiac Care will result in
sustainable, significantly improved provision of patient care and enhanced
academic medical activity in Guyana. This will be accomplished through
educational, research, and clinical initiatives.