Summary of ICIUM Chronic Care Track

1. Summary of ICIUMChronic Care Track Prepared by: Ricardo Perez-Cuevas VeronikaWirtz David Beran

2. Global setting • On the ICIUM agenda, but NOT on the global agenda • Despite UN HLM • Double burden and aging population and their impact on health systems • Life long pharmaco therapy • In the frame of behavioural changes • Wide ranging issues of: • Equity • Sustainability • Access

3. Key messages • Interrelations and interdependence between each element of the health system • Taking a systems perspective • Changes in one area of the system may have unintended consequences in another part • Role of community in delivering care • Patient not only one chronic disease • Multiple specialities • Multiple consultations • Multiple medicines • Acute episodes or acute diseases in a chronic patient

4. Key messages • Poor adherence • Patient education and cost often described as main limiting factors • Poor health outcomes – Patient • Wasted resources – Health system • Accessibility and affordability to medicines and treatment • Private sector • Gaps between optimal and actual care • Low adherence to standard treatment guidelines • Complexity and need for multiple levels of data collection • New challenge • Lack of data • Data collection tools not in place or not adapted

5. Policy recommendations • Policies • Evidence based, Developed, Enforced, Evaluated • Taxation of medicines • Universal healthcare coverage • Sustainable financing • Accessibility and affordability to all aspects of care need to be addressed together • Rational decisions throughout process of drug supply and procurement • Inclusion of prevention

6. Policy recommendations • Home and community is place of care for Chronic Conditions • Patient education and empowerment and the role of the community • Patient advocates • Education • Adapted to socio-economic and educational level • About disease • About medicines (Generics, Prices, Adverse events, etc.) • Self-management • Peer educators • Expert patients • Role of family and friends (social network) • Public education campaigns (role of NGOs)

7. Policy recommendations • Role of information systems • Inform, analyse and evaluate practice, programmes and policy • Decision making tools • Clinical information • Medicine price information • Feedback and use of data • Planning, Reporting, Research, Monitoring and Evaluation as part of the system • Use of existing research methodologies when possible • Translate research into policy

8. Policy recommendations • Development of Guidelines and training • Adapted, Evidence based, Independent, Patient focused • For referral • Adapted to each level of the health system • E.g. role of PHC in Chronic Care • Development with patient involvement • Training (curricula of academic institutions and CME) in not only clinical care and medicines, but also: • Attitude of health professionals • Management of long-term conditions • Patient education • Patient doctor communication

9. Research gaps • New challenge • Systems thinking approach • Use existing methodologies where appropriate • Standardisation of methodologies • Build on methodologies from other areas • Economic analysis of interventions • Patient focus in health systems research (pathway and experience) • Multi-morbidity • Adherence • Private sector gap exists • Guideline implementation (optimisation) • Patient education “best ways” – from pilot to scale up • Role of family and peers

10. Research gaps • Equity issues under researched • Use of research to inform policy and improve programs • Local • National • International