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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
19
75
19
77
19
79
19
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19
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19
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19
87
19
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19
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99
20
01
20
03
20
05
20
07
20
09
20
11
20
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/