Morbidity in Primary Care Dr. Abdul Sattar Khan MBBS, MPH, MCPS, DCHM, MRCGP (UK), FRIPH (UK) Assistant Professor Family Medicine Department drsattarkhan@gmail.com

Can we measure diseases? ASK

Objectives At the end of the session, the students will be able to: Understand the concept of morbidity Know the definition of incidence & prevalence Explain the current status of expertise in family medicine in Turkey Explain why is a different pattern of morbidity in the practice of family medicine Count common diseases Advocate the importance of family medicine expertise in health care ASK

Definition Morbid: Morbidity: Morbidity Rate: the discipline that applies mathematical and statistical methods to assess risk Morbid: Morbidity: Morbidity Rate: Morbidity (from Latin morbidus, meaning "sick, unhealthy") is a diseased state, disability, or poor health due to any cause. In epidemiology and actuarial science, the term morbidity rate can refer to either the incidence rate, or the prevalence of a disease or medical condition.. ASK

Measures of Disease Frequency Prevalence Rate Incidence rate ASK

Types of Fractions Used in Describing Disease Frequency ASK

Ratio- A fraction in which….. the numerator is not part of the denominator. e.g. Males & Female Ratio in the class Proportion- A fraction in which….. the numerator is part of the denominator. e.g. Fetal Death in the community: Fetal deaths/all births Rate- A proportion in which….. change over time is considered e.g. Infant Mortality Rate: Infant deaths/live births (17/1000 live births) ASK

Prevalence rate ASK

1. Point prevalence rate Proportion of individuals in a specified population at risk who have the disease of Interest at a given point in time. (when the type of prevalence rate is not specified it is usually point prevalence) ASK

2. Period prevalence rate Proportion of individuals in a specified population at risk who have the disease of interest over a specified period of time. For example: annual prevalence rate, lifetime prevalence rate.

Incidence rate ASK

1. Cumulative incidence rate Number of new cases of disease occurring over a specified period of time in a population at risk at the beginning of the interval. ASK

2. Incidence density Number of new cases of disease occurring over a specified period of time in a population at risk throughout the interval. ASK

Health Transformation Program in Turkey by Ministry of Health New era in primary health care: Family medicine ASK

Primary health care is on the rise ASK The Ministry of Health of Turkey Health Statistics Yearbook - 2008

Referral Rate drop ASK The Ministry of Health of Turkey 2009 ASK The Ministry of Health of Turkey Health Statistics Yearbook - 2008

EUROPEP Scale Satisfaction Survey in 81 provinces for 2009 Overall satisfaction level of our citizens with primary health care in the provinces where family medicine has been launched is around 83%. ASK The Ministry of Health of Turkey Health Statistics Yearbook - 2008

Common problems encounter at primary health care High Blood Glucose High Blood Pressure High cholesterol Arthritis Depression Low back pain Fatigue Impaired memory 9. Anxiety Eating disorders Obesity STI Headache Conjunctivitis ASK

Distribution of Hospital Discharges by ICD-10 Main Diagnosis Codes and Gender, (%), Turkey, 2008 ICD10 Diagnosis Codes Code Female Male Total Infectious and Parasitic A00 B99 2.7 4.0 3.2 Neoplasm C00 D49 5.0 7.1 5.9 Blood & Immune mechanism D50 D89 1.3 Endocrine, Nutritional and Metabolic E00 E99 3.3 2.4 2.9 Circulatory system 100 -199 7.8 13.5 10.2 Respiratory system J00 J99 8.4 15.0 11.2 Digestive system K00 K99 6.9 10.1 8.3 ASK The Ministry of Health of Turkey Health Statistics Yearbook - 2008

Why primary care? ASK

System characteristics Better health outcomes Lower costs Greater equity in health ASK

Practice Characteristics First-contact Longitudinality Comprehensiveness Coordination Family-centeredness Community orientation ASK

Summary Define morbidity? Can you count 10 most common problems encounter at PHC? Is is important to have primary care ? What is patient-centered approach? ASK

Thanks Teşekkürler ASK