Lecture1-Chronic Disease Management

7/30/2019 Lecture1-Chronic Disease Management

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Majid Ali

October 2010

School of PharmacyUniversity of Hertfordshire

Chronic Disease Management


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Learning Outcomes

At the end of the session students shouldbe able to identify:

What is chronic disease (with examples)

Increasing rate and seriousness of chronicdiseases

How and why pharmacists can be helpful

Tools pharmacists can use to manage chronic

diseases

Changing role of pharmacists and community

pharmacy in context of New NHS Vision and

Pharmacy White Paper (relevance to chronic


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A Chronic Disease is Defined as:

a disease lasting for one or more years,

with no cure and worsening symptoms,

which has the ability to limit lifestyle

-World Health

Organisation


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Examples of Chronic Diseases

Arthritis

Diabetes

Epilepsy

Heart diseases and strokeAsthma

COPD


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Why is chronic disease an

important health issue?

Social circumstances affect the chance ofhaving a chronic disease to a large extent

Some patients have multiple chronic

diseases, which makes their careparticularly complex

A small number of patients and diseases

account for a disproportionate amount ofhealthcare use (especially hospital care)


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Did you know??

35 000 000

people died fromchronic diseases

in 2005


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Global Mortality: A Select Comparison of

Leading Causes of Death (2004-2030)


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World Health Statistics 2008 Report

Chronic diseases, such as heart disease

and stroke, are overtaking infectious

diseases like tuberculosis and malaria as

the main causes of death across the world

Over the next 25 years the number of

deaths attributed to non-communicable

disease will rise significantly as the worldspopulation continues to live longer


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By 2030 the top four causes of death will be

ischaemic heart disease, stroke, chronic

obstructive pulmonary disease and lower

respiratory disease (mostly pneumonia)

Deaths from HIV are expected to rise to a

peak in 2012 when the disease will be

responsible for ending 2.4 million lives

In 2012 chronic disease and death

following a road traffic accident are

expected to be responsible for around a


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Chronic Diseases in England

60% of adults in England

report a chronic healthproblem


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Diabetes Mellitus (DM): 1.3m people with DM andperhaps another million undiagnosed

COPD: 600,000 people

Asthma: 3.7madults and 1.5m children

Arthritis: 8.5m

Epilepsy: 400,000 sufferers England & Wales

Mental illness: 1 in 6 of the population, including 1in 10 children

8.8m people in England have long term illness that

severely limits their day to day ability to cope.


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Risk Factors for Chronic

Diseases

Most chronic diseases are caused by asmall number of preventable risk factors

such as: unhealthy diet, lack of exercise

and tobacco use.


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Management of Chronic

Diseases

Chronic diseases can be bettermanaged through

Increased support for self care

Strengthening usual primary care

Offering responsive specialist care

Managing vulnerable cases by

anticipating their needs


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Components Required for Good

Chronic Disease Management

Identifying patients with chronic disease

Using information systems to access dataabout individuals and populations

Stratifying patients by risk

Involving patients in their own care

Co-ordinating care

Using multidisciplinary teams


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What models of chronic disease

management are being used?

The overall model for chronic disease

management requires a whole system approach

and this has been divided into three levels (nextslide):


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Kaiser Model

of Care

o t

Detecting poorly controlled conditions rapidly

Identifying patients at risk and initiating actions to prevent

deterioration

Ensuring medicines are used to optimum effect

Independent & Supplementary prescribing

It could also involve disease-specific care managers

(pharmacists with specific areas of expertise)

Limiting inappropriate hospital admissions by managing

medicines in the community

Ensuring hospital discharge is safe by providing medical

support

Mentoring APNs (advanced primary nurses) or acting as

Advanced Primary Practitioners.

health promotion and counselling

practical help, providing compliance

aids if necessary

OTC advice


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Why should pharmacist getinvolved?

Easily accessed healthcare point

It is estimated that half of all people witha chronic disease fail to take theirmedicines properly

Pharmacists have the medical expertise

and accessibility to help improve thisnoncompliance


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Gives them opportunity to help patients,keep them out of hospital, educate them

and their carer about their medication

Be recognised in local team with otherhealth and social care professional

Become responsible in medication

review (NSF older people) Enhanced reputation, better use of

pharmacists skills and job satisfaction


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Tools Pharmacists can Use to

Help with Chronic Diseases

History taking Medicines use reviews (MURs)

Patient profiles

Health promotion Ward rounds

Outpatient clinics

Chronic diseases management clinics

Repeat prescriptions

Patient group directions (PGDs)

Pharmacist prescribing

Expert patient


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Services for diabetes such as bloodtesting, foot checks and retinal

screening in community pharmacies

Implications of the new GMS andpharmacy contract for improving the

quality of care of people with long-term

conditions US style managed care providers and

pharmaceutical companies in the field of

chronic disease management


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The Role of Pharmacy in the New

Vision of the NHS Easier access to medicines

Easier and more convenient for patients to get

the medicines they need safely

Expanding the range of medicines that

pharmacies can provide without a prescription


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Increasing the range of healthcareprofessionals who can prescribe drugsto patients

New pharmacies to locate in areas suchas one-stop primary care centres

DoH will facilitate the establishment ofpharmacies intending to open more than

100 hours a week or to operate whollyvia mail order or the internet


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Pharmacy White Paper 2008

How pharmacy can contribute in chronicdisease management

Health campaigns aimed at improving

awareness of the risks associated with certainlong-term conditions

Improving medicines-related care for people

with long-term conditions to reduce

emergency admissions Screening services within national guidelines

following UK National Screening Committee

recommendations to identify those at risk of

developing, or who have already developed, a


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Medication reviews and adherenceprogrammes to improve medicine taking,

tailored for particular conditions, including

advice on new medicines, side effects, etc

Monitoring with dedicated clinics using

prescribing or patient group directions to help

control cholesterol for those on statins and

blood pressure for those on antihypertensives Signposting to social care information and

aligning care plans

Prevention and early detection of some

cancers


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Take Aways

Chronic disease is a disease lasting forone or more years, with no cure and

worsening symptoms, which has the

ability to limit lifestyle e.g. diabetes,asthma etc.

60% of worldwide deaths in 2005 were

due to chronic diseases By 2030 top three leading causes

(diseases) of deaths will be chronic

diseases


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Chronic disease management requiresidentification, risk stratification and

individualised patient management

Role of pharmacist as main point of contact isessential in chronic disease management

Pharmacists can utilise MURs, PMRs,

medication profiles, PGDs, expert patients in

chronic disease management Government in the form of New NHS Vision

and Pharmacy White Paper has recognised

the potential role of pharmacists in chronic

disease management


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Useful Resources

http://www.psnc.org.uk/index.php?type=page&pid=19&k=5

http://www.who.int/topics/chronic_diseases/en/

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D

H_4075214

http://www.dh.gov.uk/en/Publicationsandstatistic

s/Publications/PublicationsPolicyAndGuidance/DH_4070097
http://www.psnc.org.uk/index.php?type=page&pid=19&k=5http://www.psnc.org.uk/index.php?type=page&pid=19&k=5http://www.who.int/topics/chronic_diseases/en/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4075214http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4075214http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4075214http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4070097http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4070097http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4070097http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4070097http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4070097http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4070097http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4075214http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4075214http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4075214http://www.who.int/topics/chronic_diseases/en/http://www.psnc.org.uk/index.php?type=page&pid=19&k=5http://www.psnc.org.uk/index.php?type=page&pid=19&k=5


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Image on slide6 retrieved from

http://images.google.co.uk/imgres?imgurl=http://patientsandpate

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cause-over-three-quarters-of-all-deaths-by-

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Lecture1-Chronic Disease Management

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