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ChaisriSupornsilaphachai
DepartmentofDiseasesControl;MOPH;Thailand PresentedinMeetingtheChronicDiseaseChallenge HighLevelRegionalWorkshop Jakarta,Indonesia June2021,2011
What is Integrated Diseases Management ? Why is it important ? What have we already developed How about the role of partnerships ? What next ?
The word integration stems from the Latin verb integer, that is, to complete. The adjective integrated means organic part of a whole, or reunited parts of a whole. It is mostly used to express the bringing together or merging of elements or components that were formerly separate. The idea of comprehensiveness overlaps with that of integration
The meaning implied in the WHO quotation Integrated, Integrated health service, Integrated Service, Integration .can be summarized as:
The management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system.
Chronic disease prevention and management consists of a group of coherent interventions, designed to prevent or manage one or more chronic conditions using a community wide, systematic and structured multidisciplinary approach potentially employing multiple treatment modalities.
The management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system.
Key questions under this definition are:
What interventions should be packaged together? How are management support systems best organized to service these interventions?
TheGoalofChronicDiseasePrevention andManagement:
toidentifypersonswithoneormorechronic conditions, topromoteselfmanagementbypatients toaddresstheillnessorconditionsaccordingto diseaseseverityandpatientneedsandbasedonthe bestavailableevidence,maximizingclinical eectivenessandeciencyregardlessoftreatment setting(s)ortypicalreimbursementpatterns. toallowroutineprocessandoutcomemeasurements forfeedbacktoallthoseinvolved,aswellastoadapt theprogramme.
Why is it important?
- Rapid growing threat and impact of chronic diseases - The natural course of chronic diseases - How to start and mobilize our health system to response
TrendofDiabetesandHypertensionPrevalence
WhyPreventionmore Focused
1998
Stroke/Renal Failure/ISHD
Suspected Case
THAILAND
HBP, HT HBS, DM
Stroke/Renal Failure/ISHD
BNCD/Chai/ 27-9-48
2004
Stroke/Renal Failure/ISHD
Suspected Case
THAILAND
HBP, HT HBS, DM
Stroke/Renal Failure/ISHD
BNCD/Chai/ 27-9-48
percentage
Male female 80% 3% 15% 1% Total 95% 4% 1% 100%
Total productivity loss from 12 BOD = 219,560 million baht ~ 3.1% of GDP in 2005 Note: GDP in 2548 = 7,104,228 million baht
Ratio of Doctors in 1,000 Population; Compared among the countries in the near economic level
Country
Latin America & Caribbean Europe & Central Asia Malaysia Thailand Phillippine Vietnam
GDP/Capita
6950 6900 8500 6890 4450 2300
Physician/1000
1.4 3.1 0.7 0.4 1.2 0.5
Why Prevention more Focused
Sritara P et al.
Table: Percentage of Population who have Risk Factors by Age, Sex, Numbers of Risk Factors
Numbers of Risk Factors 1 Risk Factor 2 Risk Factors 3 Risk Factors >= 4 Risk Factors 1 Risk Factor Age (Year) 15-29 30-44 45-59 60-6 70-79 9 Male (N=18934) 80+
40. 41. 6 6 10.8 20.7 28.4 28. 2 29.9 3.1 6.7 11.9 12.0 9.1 0.3 1.8 3.4 3.4 1.6
Female (N=20356)
21.4 37.2 36.6 32.4 35.2 44.4 32.0 2 Risk Factors RiskFactors:Hypertension,Hypercholesterolemia,Diabetes,Overweight,RegularSmoker 5.4 12.4 24 25.5 27.3 22.6 14.7 : 3 Risk Factors 0.6 3.7 11.2 14.7 10.7 0.7 5.6 TNHEXAM2546
>= 4 Risk
N.B. : a Treatment of infectious disease can lead to prevention of further cases if it interrupts transmission. An example: Distal socioeconomic causes include income, education and occupation, all of which affect levels of proximal factors such as inactivity, diet, tobacco use and alcohol intake; these interact with physiological and pathophysiological causes, such as blood pressure, cholesterol levels and glucose metabolism, to cause cardiovascular disease such as stroke or coronary heart disease. The sequelae include death and disability, such as angina or hemiplegia.
Physical Environment
Population level
Individual level
Health Reform
Reform Government System Provincial and local government Policy Thailand NCD Civil society
Policy
Decentralization
MOPH
Acute
Vertical Program
Monitoring and Control
Area
Social Organization
Health care net Regulation and Law enforcement for protection from risk Support for quality of prevention and control (focused on risk reduction and qulity improvement process)
Development needed Mechanism for prevention and control
PCU/ CHC
ODC
BNCD
HMR Development
National Goal/Strategic Outline/Main Strategic Collaboration (Disease Control System: quality/ standard/ strength/transparency etc.)
2547
Countries
20
Prevention Activities
Focused on risk prevention and control and risk opportunities
Control Activities
Disease Control for prevention repeated attack and complication and consequences prevention
4.
Many Challenges
1. 2. Knowledge, technique and guide Population and community characteristics such as local culture, proportion of migration population in the area etc Information system that support surveillance and management Inadequate needed resources Other supporting system
3. 4. 5.
Stroke Fast Track Policy (policy/ target/KPI (ministry/ national monitoring)) Financial support for other supporting system Stroke risk (Universal coverage insurance, social insurance, local budget, etc)
Trend of Crude Death rate (per 100,000) in Thailand from Stroke and Key activities in 1995-2007
Hypertension Quality Standard Stroke Awareness NonHT & DM & Comprehensive Awareness pharmacologic Screening CVD Screen Care Increase Communication Thru Salt Net Campaign
Start CBI for Comprehensive risk reduction
&
& . 290251
50
Community
Resources and Policies
SelfManagement Support Delivery System Design
Health System
Health Care Organizations
Decision Support Clinical Information Systems
Improved Outcomes
Source:BureauofPolicyandStrategy,MoPH
Prevalence (%) NHES Obesity* Waist circumference** Regular Smokers Alcohol consumption (harmful) Fruit & Vegetable Low Intake*** Physical Inactivity
Male III 22.5 15.4 45.9 16.6 IV 28.4 18.6 38.7 13.2 III
female IV 40.7 45.0 2.1 1.6 III 34.4 36.1 2.3 2.1
80 20.7
83.1 16.8
76.4 24.2
81.5 20.2
78.1 22.5
82.3 18.5
NHES IV (2008-9)
Prevalence 22.0%
Awareness 28.6%
Prevalence 21.4%
Hyperten sion
Prevalence 15.5%
Awareness 12.9%
Prevalence 19.4%
Awareness 27.3%
Control 6.2%
Hypercholesterole mia
Control 14.8%
The Universal Health Care Coverage Policy for entire population Total expenditure on health (% of GDP) -3.5% GDP in 1994 and reached 4.0% in 2008 The share of public financing sources - 74.0% of THE
/ Primary Health Care
Comm unity
Awareness, environment and resources support, Competency Community for risk & diseases reduction
govern ment
Local
Family
Individual
Health Service Network , / / Public Health
Success Factors
System
58
. 30 2552