Improve Response to Chronic Disease

Global Framework for Actions to

Piyamitr Sritara MD, FRCP(London), FACP

Dean, Faculty of Medicine,

Ramathibodi Hospital, Mahidol University

Chronic Diseases• HTN

• DM

• Coronary artery/ Stroke

• OA

• COPD

• Cancer

• Mental Health Illness- depression/ dementia/ psychosis etc

• Chronic Infectious Diseases: HIV/AIDS, Hepatitis

Global Framework: Action to Improve Response to Chronic Disease

•Painful facts of NCD

•Global NCD targets for 2025

•Political Economy of NCD

• Integrated People-Centered Health Services

•Expanded Chronic Care Model

Source: https://www.who.int/ncdnet/about/4diseases/en/

Global Framework: Action to Improve Response to Chronic Disease

•Painful facts of NCD

•Global NCD targets for 2025

•Political Economy of NCD

• Integrated People-Centered Health Services

•Expanded Chronic Care Model

Source: www.who.int/nmh/global_monitoring_framework/

Source: www.who.int/nmh/global_monitoring_framework/

Diabetes: a Growing Problems

Journal of Diabetes Research March 2018

Prevalence of Obesity (BMI ≥ 25 kg/m²) in Thai population

25.8

39.6 37.830.9

24.1

11.3

32.9

25.3

45.351.8 50.7

38.4

21.6

41.8

25.6

42.7 44.941.4

32.1

17.6

37.5

0.0

10.0

20.0

30.0

40.0

50.0

60.0

15-29 30-44 45-59 60-69 70-79 ≥80 รวม

%ชาย หญง รวม

NHES IV 2009

ฉบบราง วชย เอกพลากร และคณะ

NHES V 201434.7% 37.5%

Abdominal Obesity

Obesity in Asian

Obesity. 2007;15:1036 –1042

Obesity. 2007;15:1036 –1042

Obesity. 2007;15:1036 –1042

Global Framework: Action to Improve Response to Chronic Disease

•Painful facts of NCD

•Global NCD targets for 2025

•Political Economy of NCD

• Integrated People-Centered Health Services

•Expanded Chronic Care Model

Economics cost of illnesses due to Sugar-Sweetened Beverage (SSB)

in ThailandVijj Kasemsup, M.D., Ph.D.

Faculty of Medicine, Ramathiboid Hospital, Mahidol University

Impact of SSB tax on cost of illnesses in Thailand

• SSB consumption: economic burden for Thailand >2 billion baht (US$

60 million) per year.

• Imposed tax on SSB yields reduction in SSB by 25%, saving from the

reduction of illnesses: around 500 million baht (US$ 15 million)/year

Economic Cost of Illnesses due to SSB in Thailand

DiseasesEconomic cost of NCD in Thailand

(million baht)

Estimated percentage from

SSB

Economic cost due to SSB in Thailand

(million baht)

Diabetes 24,489 5 1,224

CVD 78,976 1 790

Cancers 78,255 0.25 125

Total 181,720 0.25 – 5 2,209

Source: Modified from Burden of Disease Program, International Health Policy Program, Thailand (IHPP)

SSB Interventions

5.9

22.0

33.4

47.252.6

58.7

25.6

2.0

11.7

32.1

49.5

60.1

68.9

23.9

4.0

16.4

32.7

48.4

56.864.9

24.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

15-29 30-44 45-59 60-69 70-79 ≥80 รวมทกกลมอาย

%ชาย หญง รวม

ฉบบราง วชย เอกพลากร และคณะ

Prevalence of Hypertension (BMI ≥ 25 kg/m²) in Thai population

NHES IV 2009 NHES V 201421.4% 24.7%

Awareness and Controlled of Diabetes and Hypertension

20142014 20092009 20042004

UnDxUnDx

ControlledControlled

Salt & High blood pressure

Variety of Salt in Thai Cuisine

Global Framework: Action to Improve Response to Chronic Disease

•Painful facts of NCD

•Global NCD targets for 2025

•Political Economy of NCD

• Integrated People-Centered Health Services

•Expanded Chronic Care Model

WHO Framework for Integrated People-Centred Health Services

WHO (2015) WHO global strategy on integrated people-centred health services 2016-2026 Executive Summary

WHO Framework for Integrated People-Centred Health Services

Source: WHO (2015) WHO global strategy on integrated people-centred health services 2016-2026 Executive Summary

Chronic Care Team

• MD- managed medical aspect of care, medications and arranged for medical follow-up

• Social Worker- developed strategy for discharge to bridge community resources (VNS,

MOW), enlisted family support

• Physical Therapist- assessed falls risk gait/station developed plan for strengthening LE and

maintenance

• Occupational Therapist- assessed ADLs, provided equipt for home use

• Pharmacist- assessed meds for potential interactions, provided mediset

• Nurse- homecare visit to f/u sx, phlebotomy, fill medisets and evaluate compliance,

communicate with PCP and rest of care team

Chronic Care Model: The Evidence

• DM Improved measures of disease control (HgA1C)

• CHF Decreased hospitalizations/Cost of care

• Warfarin Clinic for long term anticoagulations

• Asthma Decreased hospitalization/cost

Global Framework: Action to Improve Response to Chronic Disease

• Painful facts of NCD

• Global NCD targets for 2025

• Political Economy of NCD

• Integrated People-Centered Health Services

• Expanded Chronic Care Model

Global Framework: Action to Improve Response to Chronic Disease

•Painful facts of NCD

•Global NCD targets for 2025

•Political Economy of NCD

• Integrated People-Centered Health Services

•Expanded Chronic Care Model