Integrated health care systems in Asia: an urgent necessity.

A rapidly aging population along with the increasing burden of patients with chronic conditions in Asia requires efficient health systems with integrated care. Although some efforts to integrate primary care and hospital care in Asia are underway, overall care delivery remains fragmented and diverse, eg, in terms of medical electronic record sharing and availability, patient registries, and empowerment of primary health care providers to handle chronic illnesses. The primary care sector requires more robust and effective initiatives targeted at specific diseases, particularly chronic conditions such as diabetes, hypertension, depression, and dementia. This can be achieved through integrated care - a health care model of collaborative care provision. For successful implementation of integrated care policy, key stakeholders need a thorough understanding of the high-risk patient population and relevant resources to tackle the imminent population demographic shift due to the extremely rapid rate of increase in the aging population in Asia.

A randomized controlled trial on the effectiveness of ear acupuncture plus structured counseling as compared to structured counseling alone in decreasing cigarette stick consumption among patients consulting in the Out Patient Department of the Philippine General Hospital

Cigarette smoking is considered to be the single most preventable cause of premature death and the most important challenge in primary care. The epidemic is already killing 20,000 Filipinos every year with the number of smoking-related deaths likely to rise steeply over the next few years. In other countries, ear acupuncture is a therapy frequently offered for this purpose. Uncontrolled studies with acupuncture have reported smoking cessation rates as high as 95 percent. There were no local studies found in the literature Objectives: The general objective of this study was to compare the effectiveness of ear acupuncture plus structured counseling versus structured counseling alone in decreasing mean cigarette stick consumption among smokers consulting in the Family Medicine Clinic. Design: This was an open randomized controlled trial of adult smokers in the contemplation and planning stage of quitting smoking and consulting in the Family Medicine Out-patient Clinic. Ear acupuncture plus structured counseling or structured counseling alone were compared as to the mean cigarette sticks consumed per day at the end of two weeks, one month, two months and three months, as well as compared as to the quit rate at the end of the three months. Intervention: The structured counseling involved a patient-centered, brief but extensive health education and goal-setting. This was given to both the control and the treatment groups. The treatment group received additional six sessions of ear acupuncture treatment. Results: In terms of demographic profile and intention to quit at baseline, there were no significant differences between the two groups (p value.05) except with regards to gender differences (p value=.02). The average number of sticks consumed per day decreased in both groups after two weeks, one month, two months and three months, but with greater decrease in mean cigarette stick consumption in the treatment group across all follow-up periods (p=.01). Quit rate at the end of three months was found to be higher in the structured counseling plus ear acupuncture group (40 percent) as compared to structured counseling alone group (18 percent) but this was not statistically significant (p value.05) No ear acupuncture complications were found in the treatment group at the end of the three month observation period. Conclusion: Structured counseling and ear acupuncture, alone and in combination, is effective in decreasing the mean cigarette stick consumption per day. But the combination of structured counseling plus ear acupuncture is more effective in decreasing cigarette consumption than structured counseling alone among adult smokers consulting in the Family Medicine Out-patient Clinic. This can be a new strategy for smoking cessation for our Filipino patients.