1. 2006
Pan American
Health
Organization

2. Dr. Alberto Barceló Regional Advisor Unit of Non Communicable Diseases
2006
REGIONAL STRATEGY AND PLAN OF ACTION ON AN INTEGRATED APPROACH TO THE PREVENTION AND CONTROL OF CHRONIC DISEASES, INCLUDING DIET, PHYSICAL ACTIVITY, AND HEALTH Montego Bay, March 5, 2007
Dr. Alberto Barceló
Regional Advisor
Unit of Non Communicable Diseases
Pan American
Health
Organization

3. Previous WHO and PAHO resolutions on NCDs:
2006
Previous WHO and PAHO resolutions on NCDs:
The WHO Global Strategy for the Prevention and Control of Chronic Diseases (WHA53.17, 2000);
Cardiovascular Disease, especially Hypertension (CD42.R9, 2000);
Public Health Response to Chronic Diseases (CSP26/15, 2002)
Framework Convention for Tobacco Control (WHA56.1, 2003);
Global Strategy on Diet, Physical Activity, and Health (WHA57.17, 2004); and
Cancer Prevention and Control (WHA58.22, 2005)
Pan American
Health
Organization

4. 2006
Reducing chronic disease mortality by 2% annually would result in an estimated 36 million fewer deaths between 2005 and 2015 worldwide, of which 28 million would be averted in low-income and middle-income countries
Kathleen Strong, Colin Mathers,Stephen Leeder, Robert Beaglehole. Preventing chronic diseases: how many lives can we save? Lancet S (05)
Pan American
Health
Organization

5. Port of Spain NCD Summit Declaration, 2007
2006
Ministries of Health in collaboration with other sectors in the Caribbean will establish by mid 2008 comprehensive plans for the screening and management of chronic diseases and risk factors so that by 2012, 80% of people with chronic diseases would receive quality care
Port of Spain NCD Summit Declaration, 2007
Pan American
Health
Organization

6. Major chronic diseases and their risk factors
2006
Major chronic diseases and their risk factors
Cardiovascular diseases
Cancers
Diabetes
Chronic respiratory diseases
Injuries and violence
Mental health disorders
Risk factors of unhealthy diet, physical inactivity, tobacco, and alcohol abuse
The diseases that are responsible for the majority of the premature death and disability associated with chronic conditions are:
cardiovascular diseases including hypertension, cancers and diabetes.
It is known that the major causes of chronic diseases are the risk factors of unhealthy diet, physical inactivity, and tobacco use. The recent WHO report stresses that if these major risk factors were eliminated, at least 80% of all heart disease, stroke and type 2 diabetes would be prevented; over 40% of cancer would be prevented
(Source: Preventing Chronic Diseases: a vital investment, 2005).
Pan American
Health
Organization

7. Countries’ capacity Lack of integrated action on chronic diseases;
2006
Lack of integrated action on chronic diseases;
Countries still lacking tobacco-control or food and nutrition legislation as part of the prevention and control of chronic diseases;
Few countries have assigned resources to NCD prevention and control.
Source: WHO survey on country NCD capacity, 2005
In 2005, a national capacity chronic disease prevention and control survey was carried out in the Region. The survey was conducted through PAHO’s country offices and thus far 25 countries have responded. Preliminary analysis indicates that thus far, the response to the growing epidemic of chronic diseases has been inadequate. Namely:
There is a lack of integrated action on chronic diseases;
Countries are still lacking tobacco-control or food and nutrition legislation as part of the prevention and control of chronic diseases;
Few countries have assigned resources to NCD prevention and control.
Pan American
Health
Organization

8. 2006
PAHO’s response
Regional Strategy and Plan of Action for the Integrated Prevention and Control of NCD Including Diet and Physical Activity
Pan American
Health
Organization

9. 2006
Goal: To prevent and reduce the burden of chronic diseases and related risk factors in the Americas.
Pan American
Health
Organization

10. 2006
Lines of action
Pan American
Health
Organization

11. Public Policy & Advocacy
2006
Public Policy & Advocacy
Surveillance
Health Promotion & Prevention
Integrated Management of NCD
Pan American
Health
Organization

12. Implement strategies and actions for health promotion in key settings
Health Promotion & Prevention
2006
To foster, support, and promote social and economic conditions that address the determinants of chronic diseases and empower people to increase control over their health and to adopt healthy behaviors.
Implement strategies and actions for health promotion in key settings
Pan American
Health
Organization

13. Strengthen NCD public policy development
2006
To ensure and promote the development and implementation of effective, integrated, sustainable, and evidence-based public policies on chronic disease, their risk factors, and determinants.
Public Policy
Strengthen NCD public policy development
Pan American
Health
Organization

14. Development and strengthening of chronic disease surveillance systems
2006
Surveillance
To encourage and support the development and strengthening of countries’ capacity for better surveillance of chronic diseases, their consequences, their risk factors, and the impact of public health interventions.
Pan American
Health
Organization

15. Integrated Management of NCD
2006
Provide technical assistance to countries in the development, strengthening, implementation, and evaluation of their chronic disease programs
Integrated Management of NCD
To facilitate and support the strengthening of the capacity and competencies of the health system for the integrated management of chronic diseases and their risk factors.
Pan American
Health
Organization

16. STEPWISE IMPLEMENTATION
2006
STEPWISE IMPLEMENTATION
STEP 3:DESIRABLE
STEP 2:EXPANDED
STEP 1:CORE
Pan American
Health
Organization

17. Example of objectives and indicators for a national diabetes / hypertension implementation plan as part of the chronic disease strategy
2006
Objective
Indicator
Opportunistic screening of blood glucose, blood pressure, body weight and physical activity pattern
Number of cases screened
Number of new cases of DM
Number of new cases of hypertension
Provide continuous quality diabetes and hypertension care
Number of people with diabetes or hypertension participating in educational activity
Increase coverage of A1c
Number of A1c tests among people with diabetes
Pan American
Health
Organization

18. The Chronic Care Model Overview
2006
The Chronic Care Model
Overview
Montego Bay
March 5, 2008
Pan American
Health
Organization

19. 2006
Chronic Care Model
The Chronic Care Model developed by the MacColl Institute for Healthcare Innovation (USA) provides a road map for redesigning the system to better manage chronic conditions
This model can be applied to a variety of chronic illnesses, health care settings and target populations
Pan American
Health
Organization

20. 2006
Chronic Care Model
The model has been adopted by the PAHO as the basis for action plan for managing chronic conditions
Is used in many countries and health care organizations around the world
Has been shown to be useful in organizing strategies to improve patient outcomes and reduce costs for many chronic conditions
Pan American
Health
Organization

21. Chronic Care Model Improved Outcomes HEALTH SYSTEM Productive
2006
HEALTH SYSTEM
COMMUNITY
Health Care Organizations
Self- Management Support
Clinical Information System
Resources & Policies
Delivery System Design
Decision
Support
Informed,
Empowered
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Improved Outcomes
Pan American
Health
Organization

22. Chronic Care Model Improved Outcomes HEALTH SYSTEM Productive
2006
HEALTH SYSTEM
Health Care Organizations
COMMUNITY
Self- Management Support
Clinical Information System
Resources & Policies
Delivery System Design
Decision
Support
Informed,
Empowered
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Improved Outcomes
Pan American
Health
Organization

23. Six Focal Areas Health Care Organizations
2006
Six Focal Areas
Health Care Organizations
Visibly support improvement in chronic illness care at all levels of the organization
Provide incentives to encourage better chronic illness care
Facilitate care coordination throughout the organization
Pan American
Health
Organization

24. Chronic Care Model Improved Outcomes HEALTH SYSTEM Productive
2006
HEALTH SYSTEM
COMMUNITY
Health Care Organizations
Self- Management Support
Clinical Information System
Resources & Policies
Delivery System Design
Decision
Support
Informed,
Empowered
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Improved Outcomes
Pan American
Health
Organization

25. Six Focal Areas Community Resources & Policies
2006
Six Focal Areas
Community Resources & Policies
Form partnerships with community organizations to support and develop interventions that fill gaps in needed services
Encourage patients to participate in effective community programs
Advocate for policies to promote health, prevent disease and improve patient care
Pan American
Health
Organization

26. Chronic Care Model Improved Outcomes HEALTH SYSTEM Productive
2006
HEALTH SYSTEM
COMMUNITY
Health Care Organizations
Self- Management Support
Clinical Information System
Resources & Policies
Delivery System Design
Decision
Support
Informed,
Empowered
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Improved Outcomes
Pan American
Health
Organization

27. Six Focal Areas Self-Management Support
2006
Six Focal Areas
Self-Management Support
Emphasize the patient’s central role in managing his/her health
Use effective self-management support strategies that include goal setting, action planning and problem-solving
Organize internal and community resources to provide ongoing self-management support to patients
Pan American
Health
Organization

28. Chronic Care Model Improved Outcomes HEALTH SYSTEM Productive
2006
HEALTH SYSTEM
COMMUNITY
Health Care Organizations
Self- Management Support
Clinical Information System
Resources & Policies
Delivery System Design
Decision
Support
Informed,
Empowered
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Improved Outcomes
Pan American
Health
Organization

29. Six Focal Areas Decision Support
2006
Six Focal Areas
Decision Support
Embed evidence-based guidelines into daily clinical practice
Share evidence-based guidelines and information with patients to encourage their participation
Integrate specialist expertise and primary care
Pan American
Health
Organization

30. Chronic Care Model Improved Outcomes HEALTH SYSTEM Productive
2006
HEALTH SYSTEM
COMMUNITY
Health Care Organizations
Self- Management Support
Clinical Information System
Resources & Policies
Delivery System Design
Decision
Support
Informed,
Empowered
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Improved Outcomes
Pan American
Health
Organization

31. Six Focal Areas Delivery System Design
2006
Six Focal Areas
Delivery System Design
Define roles and distribute tasks among team members
Use planned interactions to support evidence-based care
Ensure regular follow-up by the care team
Give care that patients understand and that fits with their cultural background
Pan American
Health
Organization

32. Chronic Care Model Improved Outcomes HEALTH SYSTEM Productive
2006
HEALTH SYSTEM
COMMUNITY
Health Care Organizations
Self- Management Support
Clinical Information System
Resources & Policies
Delivery System Design
Decision
Support
Informed,
Empowered
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Improved Outcomes
Pan American
Health
Organization

33. Six Focal Areas Clinical Information Systems
2006
Six Focal Areas
Clinical Information Systems
Provide timely reminders for providers and patients
Identify subpopulations for proactive care
Facilitate individual care planning
Share information with patients and providers to coordinate care
Monitor performance of practice team and care system
Pan American
Health
Organization

34. 2006
Guiding and supporting national quality improvement initiatives for diabetes a proof of concept project in the Caribbean
Pan American
Health
Organization

35. 2006
Build up on existing strategies such as the CHRC guidelines, the Caribbean Protocol for Nutritional Management of Diabetes and Hypertension, CCH3
Pan American
Health
Organization

36. to improve the quality of life of people with diabetes. Objective
2006
The goal
to improve the quality of life of people with diabetes.
Objective
To achieve real and sustained improvements in the quality of diabetes care and outcomes in 10 Caribbean countries.
Pan American
Health
Organization

37. Each country will identify the intervention areas
2006
Each country will identify the intervention areas
Antigua and Barbuda,
Anguilla,
Barbados,
Belize,
Dominica,
Grenada,
Guyana,
Jamaica,
St Lucia,
St Kitts and Nevis,
St Vincent and the Grenadines,
Trinidad and Tobago, and
Suriname.
Pan American
Health
Organization

38. The National Teams The Local Teams The Faculty Three Teams
2006
Three Teams
The National Teams
The Local Teams
The Faculty
Pan American
Health
Organization

39. 2006
The National Teams
The national technical committee will responsible at the country level. The team will consist of people with sufficient authority to implement changes in diabetes care.
Pan American
Health
Organization

40. 2006
The Local Teams
The local teams will conduct the intervention in each participating center; members of the local teams will be the Director/Coordinator of the health center and health care providers.
Pan American
Health
Organization

41. 2006
The Faculty
The role of the faculty of experts will be to provide detailed guidance and support to each country in the design, implementation and evaluation of initiatives to improve diabetes care.
Pan American
Health
Organization

42. Activities Baseline assessment Initial International Training workshop
2006
Activities
Baseline assessment
Initial International Training workshop
Chronic care model
Breakthrough series methodology
Assessment of Chronic Illness Care (ACIC) tool
Intervention
Pan American
Health
Organization

43. 2006
Expected Results
To increase the knowledge about the chronic care model and its components: Clinical information system, decision support, delivery system design, and self management.
To describe the specific changes in the clinical information system, decision support, delivery system design, and self management that have already been tried in other experiences.
Pan American
Health
Organization

44. 2006
Expected Results
Discuss the Improvement model, including the change and the need for the PDSA cycles.
Support the teams in the application of the model and the PDSA cycles, especially the first step (Plan-Do) for each one of the changes that are planned.
Achieve real improvement in the management of diabetes.
Pan American
Health
Organization

45. 2006
Conclusions
The NCD strategy and plan of action provides a framework to organize chronic disease prevention and control across the region
The use of the chronic care provides a framework to evaluate and organize NCD management
The Caribbean diabetes project focuses on improving chronic care and it is an entry point to initiate quality improvement strategies in the Caribbean
Pan American
Health
Organization