Europe GARD Country activities and National Action Plans ...
Transcript of Europe GARD Country activities and National Action Plans ...
Ministerio della Salute Roma, October 2014
Europe GARD Country activities and National Action Plans against CRD
- Portugal -
J. Rosado Pinto GARD Portugal Coordinator
PORTUGAL
Population- 10.600.000inh
GDP per capita - 23.800$
Life expectancy – Female 82,9 | Male 76,9
Healthy life expectancy at birth - 71y
Neonatal mortality rate/ 1000 live birth: 1,8
Safest countries for new borns – 10th
Life expectancy at birth among women – 10th
Rating UNDP Report (2014) – 41º
LEADING CAUSES OF DEATH IN PORTUGAL
Source: INE, IP, 2013
Cancer
Cardiovascular diseases
Respiratory diseases
YEAR
31%
25%
12%
Cancer
Cardiovascular diseases
Respiratory diseases
Cardiovascular Diseases
Diabetes
Respiratory Diseases
Infectious and Parasitic Diseases
AIDS
Cancer
Injuries and Poisoning
Digestive Diseases
Tuberculosis
Suicide
LEADING CAUSES OF HOSPITAL DEATH, PORTUGAL (2012)
Source: GDH´s- ACSS/DGS, 2013
12803
10231 9820
3613
428
0
2000
4000
6000
8000
10000
12000
14000
D. AparelhoRespiratório
Neoplasias D. AparelhoCirculatório
D. AparelhoDigestivo
D. S. Nervoso
1st
2nd
3rd
4th
5th
Respiratory Cancer Cardiovascular Digestive system Nervous system Diseases Diseases Diseases Diseases
RESPIRATORY DISEASES STANDARDIZED MORTALITY
RATE/100 000 INHABITANTS
Source: INE, IP, 2014
500 474,3
452,3
522,5
100
300
500
2009 2010 2011 2012
(under 65 years) (65 or more)
8,5
7,2
7,5
6,2
0
2
4
6
8
10
2009 2010 2011 2012
Source: GDH´s- ACSS/DGS, 2013
LEADING CAUSES OF HOSPITAL ADMISSIONS, PORTUGAL (2012)
142767
130704
122714 120039 115145
0
20000
40000
60000
80000
100000
120000
140000
160000
D. AparelhoCirculatório
D. S. Nervoso Neoplasias D. AparelhoDigestivo
D. AparelhoRespiratório
1st
2nd
3rd
4th
5th
Cardiovascular Nervous system Cancer Digestive system Respiratory Diseases Diseases Diseases Diseases
1. Promote prevention, especially 2nd and 3rd, with specific plans for 100% of health regions.
2. Contribute to the early diagnosis, increasing accessibility to spirometry in 30% in Primary Health Care
3. Optimize the use of therapeutic devices (spacer devices) reducing by 30% the aerosol therapy
4. Improve the efficiency of prescribing, increasing to 50% via electronic prescribing Respiratory Home Care
5. Improve the accessibility of Respiratory Patients by implementing a referral network for Chronic Respiratory Disease (CRD)
6. Reduce hospitalizations for CRD in 10%
7. Reducing mortality from respiratory disease in 2%
CONDITIONS WITH HIGH PREVALENCE
• Asthma
• COPD
• Sleep Apnea
CONDITIONS NEEDING HIGH DIFERENTIATION
• Cystic Fibrosis
• Pulmonary Hypertension
• Interstitial Diseases
ASTHMA MORTALITY – PORTUGAL (RATE 100.000 INHABITANTS)
Morais-Almeida M, Fonseca J, Bugalho-Almeida A. Epidemiology Severe Asthma 2010
Male Female
ASTHMA National survey 2010
• Cumulative prevalence
Asthma …………………. 1080000 – 10,5% [9.5-11.6]
Rhinitis ………………… 2273000 – 22.1% [20.7-23.6]
Controlled Asthma … 57%
In the last year: 23% went to an
emergency room
3% were hospitalized (around 20500)
68%
had one or more medical appointment
34%
had no asthma medication adjustment
72% medication in the last 4 weeks 83% asthma diagnosed
ASTHMA National survey
ASTHMA, STANDARDIZED RATE OF HOSPITAL ADMISSIONS (/100 000) PORTUGAL/EU
Source: OECD, Health at a glance: Europe 2012
15.1
53.3
admissions
deaths
ASTHMA , EVOLUTION OF HOSPITAL ADMISSIONS AND MORTALITY – PORTUGAL
Source: ONDR 2013
Source: GDH´s- ACSS/DGS, 2013
COPD, EVOLUTION OF HOSPITAL ADMISSIONS, PORTUGAL (2007-2011)
25.6% > 1 admission
Patients discharged Patients discharged excluding ambulatory
Source: OECD, Health at a glance: Europe 2012
COPD STANDARDIZED RATE OF HOSPITAL ADMISSIONS, (/100 000) PORTUGAL /EU
71.3
183.9
COPD , EVOLUTION OF HOSPITAL ADMISSIONS AND MORTALITY – PORTUGAL
admissions
deaths
Source: ONDR 2013
PNEUMONIAE, EVOLUTION OF HOSPITAL ADMISSIONS, PORTUGAL (2010 A 2011)
Source: GDH´s- ACSS/DGS, 2013
Patients discharged Patients discharged excluding ambulatory
Source: INE, IP, 2014
3,6 2,7 2,8 2,6
-5
5
15
25
35
45
2009 2010 2011 2012
213
202,6 205,9
254,1
0
50
100
150
200
250
2009 2010 2011 2012
PNEUMONIAE, STANDARDIZED MORTALITY RATE (/ 100 000)
(under 65 years) (65 or more)
Source: DGS, 2013
HOSPITAL ADMISSIONS COSTS – RESPIRATORY DISEASES
355,1
262,7
232,1
183,8 176,4
0
50
100
150
200
250
300
350
400
D. Aparelhocardiovascular
D. S. Nervoso D. Respiratórias D. MúsculoEsqueléticas
D. Digestivas
Milh
ões €
3ª
Cost per admission
1982 €
Cardiovascular Nervous system Respiratory Musculoskeletal system Digestive system Diseases Diseases Diseases Diseases Diseases
RECOMENDATIONS
To deal with economical/financial difficulties
Increase the rate of vaccination coverage for influenza vaccination >65 y and other risk groups (free of charge)
Promote the control of risk factors at political level, namely tobacco ban legislation
Increase the accessibility to spirometry and other collaboration between PHC and hospital system
Promote the implementation, control and evaluation of the clinical guidelines on CRD
Implementation of the aging group protection
Improvement of health literacy