Family Medicine Consultant & Trainer Chronic Disease Dr. Yousif E. Elgizouli MRCGP (UK),JMHPE Family Medicine Consultant & Trainer

Objectives:- At the end of this session, student will be aware of:- Definition of chronic diseases Acute/subacute & chronic diseases Problem size Common types Major risk factors Chronic Disease Clinic Comprehensive & integration care Health promotion & prevention.

Definition:- Chronic Disease is a long-lasting condition that can be controlled but not cured.  Any condition that requires ongoing adjustments by the affected person & interactions with the health care system

Difference between acute & chronic - An acute disease lasts for just a short time but can begin rapidly and have intense symptoms. An acute disease can be mild, severe or even fatal e.g. colds, influenza and strep throat. - Chronic A chronic disease is persistent. It lasts for a long period of time and might recur. Like an acute disease, a chronic disease can be mild, severe or fatal. Chronic disease produces symptoms that last for three months or more.

Subacute Diseases Diseases that fall between acute diseases and chronic diseases are sometimes referred to as subacute diseases. A disease might be considered acute at first, then subacute after a few days or a few weeks. If the disease continues for several months, it might then be called a chronic disease. There are no standard time periods that are used to determine whether a disease is acute, subacute or chronic.

Problem Size Chronic disease is the leading cause of death and disability. It accounts for 70% of all deaths. Data from the WHO show that chronic disease is also the major cause of premature death around the world even in places where infectious disease are rampant. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable and most can be effectively controlled.

In Saudi Arabia Chronic diseases accounted for 69% of all deaths in 2002. - Total deaths 97,000 - Deaths from chronic diseases 67,000

Deaths by cause, all ages (SA-2002) CVD 35% Cancer 11% CRD 02% DM 05% Other CD 16% Communicable disease 15% Injuries

Causes of deaths

Prevalence of Overweight Men/women > 30 Ys. 2005 – 2015 (SA) Not overweight 72% 28% Overweight Not overweight 72% 28%

Women 2005 Women 2015 Overweight Not overweight 75% 25% Overweight 79% 21%

Most prominent chronic diseases:- CVD, Cancer, Chronic obstructive pulmonary disease and Type 2 diabetes.

Others Bipolar mood disease Brochiectasis Chronic kidney disease Crohn's disease Epilepsy Glaucoma Haemophilia HIV Hyperlipidaemia (high cholesterol)

Hypertension (high blood pressure) Hypothyroidism (inactive thyroid gland) Multiple sclerosis Parkinson's disease Rheumatoid arthritis Schizophrenia Systemic lupus erythematosis Ulcerative colitis

Causes of Chronic Disease Four common modifiable health risk behaviors: lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption

Common risk factors:- High blood pressure, High blood cholesterol and Overweight.

Major behavioural risk factors: Unhealthy diet, Physical inactivity and Tobacco use.

Non-modifiable risk factors Age Heredity

Socioeconomic, cultural and environmental determinants. Globalization Urbanization Population ageing

Chronic Disease Clinic (CDC) Chronic disease clinics see thousands of patients repeatedly over long periods of time with many repeated tasks associated with each patient.

Comprehensive & integration care - Why? Almost half of all people with CD have multiple conditions. Practitioners not following guidelines. Lack of care coordination Lack of active follow-up.

The Forms Adult DM/HTN Flow sheet HTN Flow Sheet CDC HBA1c Sheet Bronchial Asthma Flow Sheet Asthma Control Test Multidisciplinary Patient & Family Education Form

The Forms Referral to Integrated Medical Care Form Referral from CDC to Specialist Clinic Health Education Referral Form Referral to Clinical Pharmacist Form Diabetic Nurse Educator Referral Form CDC Documents Checklist

10 FACTS ON NONCOMMUNICABLE DISEASES

1- NCDs account for 63% of all deaths 1- NCDs account for 63% of all deaths. Noncommunicable diseases (NCDs), primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, are responsible for 63% of all deaths worldwide (36 million out 57 million global deaths)

2- 80% of NCDs deaths occur in low- and middle-income countries

3- More than 9 million of all deaths attributed to NCDs occur before the age of 60

4- Around the world, NCDs affect women and men almost equally

5- NCDs are largely preventable Noncommunicable diseases are preventable through effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol

6- NCDs are not only a health problem but a development challenge as well. Noncommunicable diseases force many people into, or entrench them in poverty due to catastrophic expenditures for treatment. They also have a large impact on undercutting productivity

7- 1.5 billion adults, 20 and older, were overweight in 2008

8- Nearly 43 million children under 5 years old were overweight in 2010

9- Tobacco use kills nearly 6 million people a year 9- Tobacco use kills nearly 6 million people a year. By 2020, this number will increase to 7.5 million, accounting for 10% of all deaths

10- Eliminating major risks could prevent most NCDs 10- Eliminating major risks could prevent most NCDs. If the major risk factors for noncommunicable diseases were eliminated, at around three-quarters of heart disease, stroke and type 2 diabetes would be prevented; and 40% of cancer would be prevented

Health promotion & prevention. “the process of enabling people to increase control over their health and its determinants, and thereby improve their health”(WHO) 2005 Is the process of empowering people to make healthy lifestyle choices and motivating them to become better self-managers e.g. Patient education, counselling and support tools that promote physical activity, improve nutrition or reduce the use of tobacco, alcohol or drugs.

Prevention: - Health promotion and disease prevention strategies focus on keeping people well and preventing diseases from occurring. These strategies are referred to as primary prevention activities. - Secondary and tertiary prevention activities focus on maintaining the health of individuals with chronic conditions, delaying progression of their conditions, and preventing complications.

Assignments:- Um-Khalid is 55 Ys-old; a house-wife and a mother for 8 children, her husband is a taxi-driver. - She is known of type 2 DM, hypertension & dyslipidaemia for the last 10 Years, her BMI is 34. - Today, her main complaint is of her right knee pain. - She is on maximum dose of oral hypoglycemic tablets + 2 antihypertensive medications & antilipids drug. - Her HGA1c is 14.5, BP 160/95

What might be the causes for the poor control of Um-Khalid condition? What are the possible complications for Um-Khalid condition? What investigations you asked for?

What advice you give her in this visit? How you integrate her care in a CDC?

What are the possible health promotion and prevention policies that might benefit others not to be as Um-Khaled in the future?

Communication/Consultation Define communication Mention 5 purposes of effective communication Mention 3 differences between consultation in hospital and primary care? Describe 5 ways to improve your consultation skills? What are the reasons for a dysfunctional consultation, give 2 reasons for each Patient, Doctor and Practice factors.