1. Summary of ICIUM Chronic Care Track Prepared by: Ricardo Perez-Cuevas Veronika Wirtz David Beran

2. Global setting On the ICIUM agenda, but NOT on the global agenda – Despite UN HLM Double burden and aging population and their impact on health systems Life long pharmaco therapy – In the frame of behavioural changes Wide ranging issues of: – Equity – Sustainability – Access

3. Key messages Interrelations and interdependence between each element of the health system – Taking a systems perspective – Changes in one area of the system may have unintended consequences in another part Role of community in delivering care Patient not only one chronic disease – Multiple specialities – Multiple consultations – Multiple medicines – Acute episodes or acute diseases in a chronic patient

4. Key messages Poor adherence – Patient education and cost often described as main limiting factors Poor health outcomes – Patient Wasted resources – Health system Accessibility and affordability to medicines and treatment Private sector Gaps between optimal and actual care – Low adherence to standard treatment guidelines Complexity and need for multiple levels of data collection New challenge – Lack of data – Data collection tools not in place or not adapted

5. Policy recommendations Policies – Evidence based, Developed, Enforced, Evaluated Taxation of medicines Universal healthcare coverage – Sustainable financing Accessibility and affordability to all aspects of care need to be addressed together Rational decisions throughout process of drug supply and procurement Inclusion of prevention

6. Policy recommendations Home and community is place of care for Chronic Conditions Patient education and empowerment and the role of the community – Patient advocates – Education Adapted to socio-economic and educational level About disease About medicines ( Generics, Prices, Adverse events, etc.) – Self-management – Peer educators Expert patients – Role of family and friends (social network) – Public education campaigns (role of NGOs)

7. Policy recommendations Role of information systems – Inform, analyse and evaluate practice, programmes and policy Decision making tools – Clinical information – Medicine price information Feedback and use of data – Planning, Reporting, Research, Monitoring and Evaluation as part of the system Use of existing research methodologies when possible – Translate research into policy

8. Policy recommendations Development of Guidelines and training – Adapted, Evidence based, Independent, Patient focused – For referral – Adapted to each level of the health system E.g. role of PHC in Chronic Care – Development with patient involvement Training (curricula of academic institutions and CME) in not only clinical care and medicines, but also: – Attitude of health professionals – Management of long-term conditions – Patient education – Patient doctor communication

9. Research gaps New challenge – Systems thinking approach – Use existing methodologies where appropriate – Standardisation of methodologies – Build on methodologies from other areas – Economic analysis of interventions Patient focus in health systems research (pathway and experience) Multi-morbidity – Adherence Private sector gap exists Guideline implementation (optimisation) Patient education “best ways” – from pilot to scale up Role of family and peers

10. Research gaps Equity issues under researched Use of research to inform policy and improve programs – Local – National – International