Chronic Disease

1. 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. By contrast, a chronic disease produces symptoms that last for three months or more. • An acute disease can be mild, severe or even fatale.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. Unlike an acute disease, a chronic disease is likely to develop over time instead of having a sudden onset

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 death. • Data from the World Health Organization 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 • 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)

9. Prevalence of OverweightMen/women > 30 Ys. 2005 – 2015 (SA) • Men 2005 • Men 2015

10. Women 2005 • Women 2015

11. Case Scenario • 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

12. Causes of deaths

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

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

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

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

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

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

19. Non-modifiable risk factors • Age • Heredity

20. Socioeconomic, cultural and environmental determinants. • Globalization • Urbanization • Population ageing

21. 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.

22. 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.

23. 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

24. 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

25. Circles of Influence in Self-Management of Chronic Disease

26. 10 FACTS ON NONCOMMUNICABLE DISEASES

27. 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)

28. 2- 80% of NCDs deaths occur in low- and middle-income countries

29. 3- More than 9 million of all deaths attributed to NCDs occur before the age of 60

30. 4- Around the world, NCDs affect women and men almost equally

31. 5- NCDs are largely preventableNoncommunicable diseases are preventable through effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol

32. 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

33. 7- 1.5 billion adults, 20 and older, were overweight in 2008

34. 8- Nearly 43 million children under 5 years old were overweight in 2010

35. 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

36. 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

37. Health promotion & prevention. • Health promotion: • “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.

38. 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.

39. 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

40. G 1 • 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?

41. G 2 • What advice you give her in this visit? • How you integrate her care in a CDC?

42. G 3 • What are the possible health promotion and prevention policies that might benefit others not to be as Um-Khaled in the future?