Nurse Educators: Bridging China's Patient Care Gap

It’s no longer surprising to hear that China has bounded ahead of the US and Europe in mobile online retail and finance, as well as hybrid entertainment and e-commerce. Long ago, companies like Alibaba and Tencent turned China into the world’s largest online grocery marketplace. These companies and others beat Amazon.com in early launches of unmanned retail shops. And, in China, there’s no need to whip out a credit card or log into PayPal to close a transaction. Millions of consumers already enjoy one-click payment inside chat, news and shopping apps and exchange digital cash using “red packets” popularized on WeChat.

Because Chinese consumers are accustomed to sophisticated digital services, in many cases, they’re also more engaged and medically savvy than their counterparts in the US or the EU. Yet, well-honed e-commerce skills and infrastructure can’t give Chinese patients what many of them crave most: access to state-of-the-art medical care.  China had just 2.3 physicians per 1,000 people in 2016, compared with more than 4 per 1,000 in Germany, Switzerland, Norway and other European countries. This year, according to Frost & Sullivan, China will experience a shortage of 3.4 million hospital beds.

Having worked with partners in Chinese hospitals, I have seen how these deficits can adversely affect both physicians and patients. Cardiologists in China typically have just two or three minutes to spend with patients who present with complex conditions such as hypertension, dyslipidemia, diabetes or respiratory ailments. It’s hardly enough time to explain the need for lifestyle changes, let alone provide advice on drug regimens.

Now, necessity is sparking social and structural innovations that improve life for Chinese patients and ease pressure on time-strapped physicians. These innovations may offer a model for improving healthcare outcomes in other developing nations, where the burden of “lifestyle diseases” is accelerating in tandem with middle class growth.

One innovation involves making effective use of nurse educators. With support from pharmaceutical companies and the staff at medical centers, these nurses make sure patients understand the conditions they need to treat, the correct way to take their medications, the importance of staying adherent, and, in some cases, the need to make lifestyle changes. In China, this kind of supplementary support must meet exacting standards of compliance and transparency as nurse educators and related staff help physicians train patients in how to manage their illnesses.

In providing patients and caregivers with comprehensive information in a variety of formats, the twin goals a nurse educator program are to improve quality of care and make life simpler for physicians handling high patient loads. Skillful communication is at the heart of this endeavor. In some cases, for example, the team may be called on to approach patients with heart disease-after receiving an introduction from the physician-and invite them to a free information session later that week. At the open session, the same physician who was able to spend just two minutes per patient in the clinic can now spend 40 minutes or an hour explaining the medical and social context. Topics at a typical session range from clarification of medical terms, to behavior and life-style recommendations, to advice on medication adherence.

In the US, in specialized areas such as cancer care or weight loss surgery, medical centers sometimes host free information sessions that give patients expanded access to physicians. Patient advocacy organizations also organize meetings of this sort. But such events are not a routine component of primary care, and direct outreach from nurse to patient is constrained by regulatory guardrails. China offers an instructive contrast. In cardiovascular care, for example, some 6,000 physicians and 80 nurse educators participated in a program run by Syneos Health last year. We estimate this program enhanced the care of more than 250,000 patients.  

The results from this program hint at what might be possible in other therapeutic areas. Consider hypercholesterolemia therapies-a familiar treatment course in the West that is growing fast in China. Without supplementary disease management education, we’ve found that well over half of patients fail to adhere to drug programs for more than 90 days. But the picture improves dramatically once patients attend a disease education session, and better  medication adherence correlates closely with improved outcomes.

Educational outreach doesn’t end with information sessions-nor would tech-savvy Chinese expect such a thing. In some cases, it’s possible to pair a nurse educator program with a local service provider such as WeChat to create a platform that connects patients, nurses, doctors and administrators. The platform may include capabilities ranging from physician payment to integrated call-center services that support both patients and doctors remotely.

Regarding the nurse educator program led by my colleague in China, Dr. Sam Ying, the roster of clients showing interest in the larger technology platform and integrated services includes both global and local pharmaceutical companies. Going forward, we also hope to introduce online patient support groups in chronic disease areas such as diabetes, rheumatology or mental health, with one or more of our pharma clients providing unbranded financial or logistical assistance.

Expanding programs like these in China fits well with a broader Chinese technological agenda. As the Financial Times recently reported, China is promoting advanced medical technologies, including cell therapies and gene editing, with hopes of becoming a destination for patients around the world seeking state-of-the-art treatments. The aspiration is already becoming a reality: China is currently conducting 116 cancer trials involving CAR-T cell therapy, compared with 96 in the US.

Meanwhile, across Asia, the healthcare industry is growing by double digits and slated to hit US$517 billion this year, according to Frost & Sullivan. But that doesn’t mean supply of goods and services will flow to sectors where there’s the greatest need. Despite many state-led programs to raise physician-to-patient ratios, shortages of doctors will persist in many regions. Outsourced nurse educator programs can help bridge the gaps to improve patient care.

Sebastian Bather is President, APAC and Japan, Syneos Health.