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

2. 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.

3. 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

4. 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.

5. 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.

6. 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.

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

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

9. Causes of deaths

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

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

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

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

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

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

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

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

18. Non-modifiable risk factors
Age
Heredity

19. Socioeconomic, cultural and environmental determinants.
Globalization
Urbanization
Population ageing

20. 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.

21. 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.

22. 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

23. 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

24. 10 FACTS ON NONCOMMUNICABLE DISEASES

25. 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)

26. 2- 80% of NCDs deaths occur in low- and middle-income countries

27. 3- More than 9 million of all deaths attributed to NCDs occur before the age of 60

28. 4- Around the world, NCDs affect women and men almost equally

29. 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

30. 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

31. 7- 1.5 billion adults, 20 and older, were overweight in 2008

32. 8- Nearly 43 million children under 5 years old were overweight in 2010

33. 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

34. 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

35. 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.

36. 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.

37. 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

38. 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?

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

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

41. 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.