Dubai Standards of Care for Diabetes - Improving Healthcare Services

1. Dubai standards of Care Dr. Mohamed FarghalyFRCGP(UK).MRCGPI(UK).DIH(IRELAND)DMSc(UK).MBChB(ALEX).A.Professor Dubai Medical CollegeHead Of Insurance Medical Regulation Dubai Health Authority

2. “I know that the goal is to make people happy” “When governments provides special healthcare, nothing makes patients happier than recovering and gaining peace of mind.” - HH Sheikh Mohammed Bin Rashid, 2013 General goals of healthcare laws and the healthcare system in Dubai Stemming from his vision to bring happiness to the community, and in line with Dubai’s strategic plan, HH Sheikh Mohammed Bin Rashid has attested healthcare laws in Dubai that aim to: Provide an integrated, high quality health system in Dubai which is flexible and can be developed to meet the needs and aspirations of beneficiaries. Achieve a global standing for the health sector and strengthen Dubai’s competitive advantage locally and globally in its pursuit to be the best in creating and implementing a healthcare system that is efficient and sustainable Ensure health security for every Emirati and resident to achieve happiness within the community and strengthen productivity Attract investments and global expertise to the health sector in Dubai

3. منظومة الضمان الصحي بدبي Insurance System for Advancing Healthcare in Dubai

4. Dubai Strategic Plan 2015 • The DHA's aim is • to provide an accessible and integrated healthcare system, • protect public health and improve the quality of life within the Emirate. • the DHA's mission is to • ensure access to health services, • maintain and improve the quality of these services, • improve the health status of nationals, residents and visitors and • oversee a dynamic, efficient and innovative health sector.

5. Vision 2021 – WORLD CLASS Healthcare • The UAE Vision 2021 National Agenda aims to achieve a world-class healthcare system. • The National Agenda emphasizes the importance of preventive medicine to ensure a longer, healthy life for citizens. • This will result in the UAE becoming among the best countries in the world in terms of quality of healthcare. • The key public health authorities highlighted key priorities that include: • Cardiovascular disease prevention and management • Tobacco control • Communicable disease prevention (this includes viral hepatitis) • Occupational health • Cancer control and prevention • Oral health • Respiratory health https://www.vision 2021.ae/en/national-priority-areas/world-class-healthcare

6. Introduction • The “Dubai Standards in Healthcare ”, a series of educational programs to provide healthcare practitioners in Dubai with best practice guidelines and standards in health care for services provided through health insurance. • The program is CME accredited educational events, designed to bring the latest updates on screening, diagnosis and prevention of various chronic conditions ,guidelines and criteria for referral • The program consists of establishing task force teams with representatives from DHA, Emirates Medical Association and Dubai Private sector to develop medical standards and audit tools based on international and national guidelines. • http://dsdc2015.com/

7. Eclaims - Major Diagnostic Categories 2015

8. Major Diagnostic Categories 2017

9. Dubai Standards of Care“Diabetes”

10. Why Diabetes? The UAE national strategy to reduce the prevalence of diabetes from 19% to 16.3% by 2021

11. Diabetes: A global emergency Diabetes: A Global Emergency Number of people with diabetes worldwide and per region in 2017 and 2045 (20-79 years) International Diabetes Federation. IDF Diabetes Atlas, 8ed. Brussels, Belgium: International Diabetes Federation, http://www.diabetesatlas.org

12. United Arab Emirates

13. Medical Regulations for Treatment based on Evidence/Guidelines (Dubai Standard of Care)Diabetes Project Diabetic patient database through insurance: • 2.4 million registered persons (2015) and > 4.8 million (2018) • 460,000 people checked • 213, 000 people with diabetes = 9% of insured people in Dubai • 435,000 people with Diabetes (2018) Results were recorded for the last 3 months. Results: • 60% HbA1c < 7 • 10% HbA1c > 9.5 Conclusion • Mandatory examinations for diabetes on all insured persons in Dubai • Declaring the medical protocol and training all doctors to use it • Following up on the development of HbA1c through an electronic system By the end of 2017: • Number of insured persons: 4.5 million • Number of people with diabetes: >400 thousand – 8.9% of the population • > 60% HbA1c less than 7 A longitudinal study that includes all people with diabetes in Dubai and not just a random sample of people in addition to the possibility of measuring results of the medical protocol and comparing it with others.

14. Dubai Standards of Care - Diabetes • Diabetes accounts for 10% of total expenditure cost in Dubai Healthcare insurance system in 2015 same figure in 2018. • “Dubai Standards in Healthcare – Diabetes Care”, a series of educational programs to provide healthcare practitioners in Dubai with best practice guidelines and standards in diabetes care for services provided through health insurance. • The aim  promote better management of people with Diabetes by providing clinicians with the right tools to elevate the quality of care. • Total registered delegates – 613 • Actual Attended Delegates  442 • Total Speakers  09 • Total Presentations 09

15. Monthly claimed amounts, AED for A1C

16. A1C Cost Savings

17. Dubai Standards of Care“Asthma”

18. Standards of CareStatus of asthmatics in Dubai • The number of asthmatic patients in the private sector of Dubai has grown 33% from 2015 to 2016 to reach more than 83,000 patients. • Patients on mono-therapy usually receive only a Short Acting B2 Agonist (SABA) reliever which they usually over-rely on and are generally uncontrolled and at risk of an exacerbation; while patients on combination therapy have a controller component and are generally better controlled at a lower risk of exacerbation. • Asthma control, even in controller-based treatment group is not ideal and is factored by many factors including: • Proper patient identification • Proper utilization of diagnostic and assessment tools e.g. ACT, PFM • Patients compliance, adherence to therapy

19. Standards of CareImpact on spending Cost of Asthma management: • Direct: Medication and consultation cost • Indirect: • Repeated outpatient visits • Treatment failure • Exacerbation • Hospitalization/ ER visits Asthma patients not receiving controllers are associated with less direct cost (medication) and a muchhigher total cost (total claims) driven by their uncontrolled Asthma • 17,574 Patients only on reliever therapy • 66,306 Patients only on controller therapy Despite the lower number of these patients, they drain more of the healthcare resources up to 6X higher indirect cost as they are more prone to exacerbation and complications leading to hospitalization and ER visits

20. Standards of Care | Alignment with guidelinesImpact on spending Using the data generated by e-claim system, we learned that with the increase use of relivers only in Asthma patients between 2015 and 2016 there was a significant increase in total associated cost, unlike patients using the guidelines-recommended controller therapy. The average cost of an asthmatic patient reflects the same.

21. Standards of CareConclusion Achieving control in asthma patients is dependant on several key factors: • Education on the latest updates in guidelines and treatment protocols • Utilization of diagnostic and assessment tools e.g. ACT, PFM, Spirometer • Adoption of patient-centered initiatives to improve adherence and promote self-management The Health Funding department in DHA has launched Dubai Standards of Care – Respiratory with the aim to standardize asthma management across Dubai to achieve better patient treatment outcomes at a lower cost.

22. Standards of CareThe journey continues 4 Dubai Standards of Care – Respiratory conducted in the last 3 years +500 healthcare professional in Dubai have taken part in DSDC 16 Educational lectures delivered 2 International speakers presented in DSDC +20,000 Increase in number of patients receiving guidelines recommended treatment (between 2015 to 2016)

23. Dubai Standards of Care“Dubai Payers Club”

24. Dubai Standards of Care“FAST”

25. Dubai Payers Club • The Dubai Payers Club is the first club in the UAE organizing a series of educational activities which provides Dubai Healthcare Payers (Insurance companies, Third party administrators) with best practice guidelines and standards for medical conditions • The aim is • to provide Payers with updates in the medical field on the management and the treatment of diseases • The demonstrate the cost effectiveness and cost efficiency of the proposed management as per Eclaim data analysis • To promote medically justified claim settlement practices • To establish a platform for discussion among DHA Healthcare Insurance Payers • The first Dubai Payers Club took place on the 31st of March, 2017

26. Payers club

27. Payers club

28. Published standards

29. New Guideline Added to the Standard • ENT • Otitis media • Acute tonsillitis • Sudden sensorineuronal hearing loss • Ototoxicity • Dizziness and vertigo • Cochlear implants • Phoniatrics and speech therapy • Rhinosinusitis • Ophthalmology • Glaucoma • Dry eye • Conjuctivitis • Rheumatoid arthritis

30. Vision 2021 – WORLD CLASS Healthcare • The UAE Vision 2021 National Agenda aims to achieve a world-class healthcare system. • The National Agenda emphasizes the importance of preventive medicine to ensure a longer, healthy life for citizens. • This will result in the UAE becoming among the best countries in the world in terms of quality of healthcare. • The key public health authorities highlighted key priorities that include: • Cardiovascular disease prevention and management • Tobacco control • Communicable disease prevention (this includes viral hepatitis) • Occupational health • Cancer control and prevention • Oral health • Respiratory health https://www.vision 2021.ae/en/national-priority-areas/world-class-healthcare

31. New Initiatives (Dubai Standard of care)BASMHA

32. DUBAI Free from HCV

33. Recent Guideline developed and will be added soon

34. Recent Guideline developed and will be added soon

35. New Data to be shared soon

36. Objectives of the study • To understand the treatment patterns among patients newly diagnosed with T2DM during one year from the date of first diabetes diagnosis in terms of • Patient characteristics • First anti-diabetic therapy (ADT) • Time to first ADT • Number of prescriptions and quantity dispensed • First monotherapy / combination therapy / insulin use • Time to therapy • Prior therapies • HbA1c prior to start of the therapy • Treatment pattern during follow-up

37. New Data to be shared soon

38. Objectives of the study • The primary objective of this study was to understand the antibiotic prescribing pattern during acute episodes of following upper respiratory tract infections (URTIs) • acute otitis media • acute rhinitis • acute rhinosinusitis • pharyngitis/tonsillitis • common cold in terms of • Proportion of episodes with and without antibiotics • Number of antibiotics prescribed • Average time to antibiotic • Type of antibiotics prescribed, by drug class • Use of concomitant medications  • The secondary objective was to study the resource use during acute episodes of URTI

39. New Initiative