Improving primary health care in Abu

Dhabi towards patient centeredness

with Chronic Care Model

Marília Silva Paulo, Tom Loney and Luís Velez Lapão

Budapest, 21st of June 2018

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UNITED ARAB EMIRATES (UAE) IS LOCATED IN THE ARABIAN PENINSULA

Dubai

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1971: economy was mainly based on pearl trading, herding, fishing and agriculture;

Huge economic and industrial growth – petroleum, aviation, maritime, construction and

health care industries (Loney, 2013);

2014: 3.6% of the GDP spent on health (WHO, 2015).

UNITED ARAB EMIRATES (UAE) ASTONISHING DEVELOPMENT SINCE 1971

10000000

9000000

8000000

7000000

6000000

5000000

4000000

3000000

2000000

1000000

0

19

71

19

73

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75

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77

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79

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81

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83

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85

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87

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89

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97

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99

20

01

20

03

20

05

20

07

20

09

20

11

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13

20

15

Population, total

Population, total

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Figure 2: Total population in the UAE from 1971 to 2015. Figure 1: Population in the UAE by nationality (Abu Dhabi 2,2017).

MAIN CHALLENGES IN UAE POPULATION’S HEALTH

Figure 3: Years lived with disability, years of life lost and risk factors in the UAE, 2016 (IHME, 2018).

65% of all the deaths in 2012 were due to non-communicable diseases (WHO, 2014);

Between 30 to 70 years old the probability of dying from NCDs is 19% (WHO, 2014);

Years of life lost (YYLS) Years lived with disability (YLDS) Risk factors

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THE CHRONIC CARE MODEL – SUPPORTING THE DESIGN OF NEW HEALTHCARE SERVICES

Wagner et al, 2001

Each element

of the model has

its own

strategies and

development

concepts that

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STUDY AIMS

Aims

The CCM aims at supporting the development of a more patient centered care.

This study aims to contribute to the achievement of a World-Class Health a e , one of the six pillars of the UAE National Vision 2021 with 10 clear priorities.

Objective

To characterize the primary health care public services in the emirate of Abu Dhabi,

in the United Arab Emirates, using the Chronic Care Model as a framework.

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METHODS: PRISMA

Eligibility criteria

English language journals or reports;

Published no more than 3 years old;

Specific search terms.

Information sources

World Health Organization, World

Bank, Institute of Health Metrics and

Evaluation, UAE MOHP, HAAD, SEHA,

and bibliographic references of the

official reports obtained.

295 Records identified through

database searching

Scr

een

ing

Incl

ud

ed

Eli

gib

ilit

y

Iden

tifi

cati

on

13 Additional reports identified

through other sources

231 Records after duplicates removed

231 Records screened

211 Record excluded

20 Full-text articles

and 13 reports assessed

for eligibility

3 Full-text articles

excluded, with reasons

30 Studies included in

qualitative synthesis

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RESULTS

In 2013, in Abu Dhabi, there were 41 private and public hospitals (10% of all are SEHA s), 587 healthcare centers (13% of all are SEHA s), 335 clinics (1% of all are SEHA s) and 402

pharmacies (14% of all are SEHA s) (HAAD, 2014).

From the SEHA 62 ambulatory healthcare centers (AHS), only one is an occupational

healthcare center, 10 are disease prevention and screening centers primarily for

infectious disease residency visa screening, and 9 dialysis centers and clinics (HAAD,

2014).

From the 38 AHS centers 20 are located in the Eastern region and 18 in the Abu Dhabi

Capital Center. The Western region does not have AHS services yet.

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80% of all AHS patients visits are PHC consultations (HAAD, 2013) with diabetes and

cardiovascular disease comprising the majority of the chronic disease case load

managed in these centres (SEHA, 2013).

In 2013, the primary health care under AHS adopted the Patient-Centred Medical

Home (PCMH) model and principles.

This model is improving patient outcomes, moderating health disparities and

reducing health resources by reducing the number of hospitals visits

Aims to inspire quality care, engage patients and expand access and delivery options

RESULTS

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Synthesis of results

and principles.

reducing the number of hospitals visits

Aims to inspire quality care, engage patients and expand access and delivery options

Patient

Primary care physician

Dietitian

Hospital

Specialty physician

Counselor

This model is improvingLapboarattoiery,nt outcomes, moderating health disparities and reducing health resources by radiology,

pharmacy

Nurse care

80% of all AHS patients visitmsaanraegerPHC consultations (HAAD, 2013) with diabetes and cardiovascular

disease comprising the majority of the chronic disease case load managed in these centers (SEHA, 2013).

In 2013, the primary health care under AHS adopted the Patient-Centered Medical Home (PCMH) model

RESULTS

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RESULTS

Model Elements Evidence in Primary Healthcare Centers Gaps

Self-Management

Support

Community

Health System

Through Health Education in SEHA's website and App:

-Information about the importance of patients decisions and daily routines that affect their Use effective self-management support

health and specifically according with the disease; strategies that include assessment, goal-setting,

-Information available about how to manage the types of Diabetes, Heart and Circulation action planning, problem-solving and follow-up

Diseases, Kidney Diseases and Health Lifestyle

- Encourage patients to participate in effective

-SEHA is establishing electronic programs and

communication channels (interactive when

community programs;

possible); - Form partnerships with

community

-In 2013, lectures on health and nutrition were

delivered for family foundation organizations

to support and develop

development schools; interventions

that fill gaps in needed services;

- Advocate for policies to improve patient care

- In 2013 SEHA launched the National Hospital Quality Measure;

- Provides performance data to the different professions;

- Set out procedures that will create shared responsibility for individuals towards their - Promote effective improvement strategies

duties. aimed at comprehensive system change; - Provides incentives based on quality of care;

Ea h SEHA s hospital have li ked A ulato y Health a e Se vi es;

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Model Elements Evidence in Primary Healthcare Centers Gaps

Delivery System Design

-Care Plans;

-Give care that patients understand and that fits with their cultural background

-Define roles and distribute tasks among team

members;

-Use planned interactions to support evidence-

based care;

-Provide clinical case management services for

complex patients;

-Ensure regular follow-up by the care team;

- I , SEHA lau hed Kafu , o su e a e develop e t p og a to

standardize costumer care by adopting the best practice; - Embed evidence-based guidelines into daily

Decision Support - Provides useful and specialized data;

- SEHA offe s i te a tive tuto ials, videos, PDF s a d uizzes a out the topi s i

clinical practice;

- Share evidence-based guidelines and information

Health Education; with patients to encourage their participation;

- Integrative teams with specialist expertise in primary care

-In case of patients with health disease SEHA facilitates an emergency plan that the

patient must know;

-The patients information is available in SEHA database and any clinic can see it

when its needed;

-The PCMH dash board has graphs, charts and spreadsheets about chronic disease

- Identify relevant subpopulations for proactive

care;

- Provide timely reminders for providers and

Clinical Information patients;

System - Share information with patients and providers to

coordinate care;

patients and doctors performance; - Monitor performance of practice team and care

system.

RESULTS

DISCUSSION AND CONCLUSIONS

Despite of the populatio s youth, the populatio s agei g a d the health out o es i a near future will lead to an enormous economical and social impact.

The aims of the PHMC are aligned with the CCM, it was undoubtedly a strategic choice.

The Abu Dhabi emirate health system is internationally well-positioned and competing with

others from the developed countries.

The PCMH model was only recently implemented in the Abu Dhabi emirate in 2013 and

there are currently no publicly available records or reports on the monitoring or evaluation

process.

As it is a country with the majority of young population we have an opportunity to engage

them in self-management through community partnerships.

There is opportunity and space for improve /implement the CCM in the UAE by promoting

a culture of continuing high quality in PHC and with few associated costs.

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THE CHRONIC CARE MODEL – POSITIVELY SUPPORTING A LEARNING PROCESS

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Wagner et al, 2001

References

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Health Authority Abu Dhabi, Dhabi A. Health Statistics 2013. [Internet]. Can. Med. Assoc. J. Abu Dhabi; 2014. Available from:

http://www.haad.ae/HAAD/LinkClick.aspx?fileticket=LrAOka_Zx3Q=&

ICIC. Improving Chronic Illness Care – Chronic Care Model [Internet]. 2014. Available from :

http://www.improvingchroniccare.org/index.phpp=The_Chronic_CareModel&s=2

Loney, T., Aw, T., Handysides, D., Ali, R., Blair, I., Grivna, M., Shah, S., Sheek-Hussein, M., El-Sadig, M., Sharif, A. and El-Obaid, Y. - An analysis

of the health status of the U ited A a E i ates: the Big pu li health issues. Glo al Health A tio , 6: . .

Paulo, M. S., Loney, T., & Lapão, L. V. (2017). The primary health care in the emirate of Abu Dhabi: are they aligned with the chronic care

model elements?. BMC health services research, 17(1), 725.

SEHA. Annual Report 2013 [Internet]. Abu Dhabi; 2013. Available from: https://www.seha.ae/English/aboutus/annualreport/Pages/AR

2013/SEHA AR-13.pdf

Wagner, E. H., Glasgow, R. E., Davis, C., Bonomi, A. E., Provost, L., McCulloch, D., ... & Sixta, C. (2001). Quality improvement in chronic

illness care: a collaborative approach. The Joint Commission journal on quality improvement, 27(2), 63-80.

WHO. World Health Organization. United Arab Emirates Country profile [Internet]. 2015. Available from:

http://www.who.int/countries/are/en/