Improve Response to Chronic Disease
Global Framework for Actions to
Piyamitr Sritara MD, FRCP(London), FACP
Dean, Faculty of Medicine,
Ramathibodi Hospital, Mahidol University
Chronic Diseases• HTN
• DM
• Coronary artery/ Stroke
• OA
• COPD
• Cancer
• Mental Health Illness- depression/ dementia/ psychosis etc
• Chronic Infectious Diseases: HIV/AIDS, Hepatitis
Global Framework: Action to Improve Response to Chronic Disease
•Painful facts of NCD
•Global NCD targets for 2025
•Political Economy of NCD
• Integrated People-Centered Health Services
•Expanded Chronic Care Model
Source: https://www.who.int/ncdnet/about/4diseases/en/
Global Framework: Action to Improve Response to Chronic Disease
•Painful facts of NCD
•Global NCD targets for 2025
•Political Economy of NCD
• Integrated People-Centered Health Services
•Expanded Chronic Care Model
Source: www.who.int/nmh/global_monitoring_framework/
Source: www.who.int/nmh/global_monitoring_framework/
Diabetes: a Growing Problems
Journal of Diabetes Research March 2018
Prevalence of Obesity (BMI ≥ 25 kg/m²) in Thai population
25.8
39.6 37.830.9
24.1
11.3
32.9
25.3
45.351.8 50.7
38.4
21.6
41.8
25.6
42.7 44.941.4
32.1
17.6
37.5
0.0
10.0
20.0
30.0
40.0
50.0
60.0
15-29 30-44 45-59 60-69 70-79 ≥80 รวม
%ชาย หญง รวม
NHES IV 2009
ฉบบราง วชย เอกพลากร และคณะ
NHES V 201434.7% 37.5%
Abdominal Obesity
Obesity in Asian
Obesity. 2007;15:1036 –1042
Obesity. 2007;15:1036 –1042
Obesity. 2007;15:1036 –1042
Global Framework: Action to Improve Response to Chronic Disease
•Painful facts of NCD
•Global NCD targets for 2025
•Political Economy of NCD
• Integrated People-Centered Health Services
•Expanded Chronic Care Model
Economics cost of illnesses due to Sugar-Sweetened Beverage (SSB)
in ThailandVijj Kasemsup, M.D., Ph.D.
Faculty of Medicine, Ramathiboid Hospital, Mahidol University
Impact of SSB tax on cost of illnesses in Thailand
• SSB consumption: economic burden for Thailand >2 billion baht (US$
60 million) per year.
• Imposed tax on SSB yields reduction in SSB by 25%, saving from the
reduction of illnesses: around 500 million baht (US$ 15 million)/year
Economic Cost of Illnesses due to SSB in Thailand
DiseasesEconomic cost of NCD in Thailand
(million baht)
Estimated percentage from
SSB
Economic cost due to SSB in Thailand
(million baht)
Diabetes 24,489 5 1,224
CVD 78,976 1 790
Cancers 78,255 0.25 125
Total 181,720 0.25 – 5 2,209
Source: Modified from Burden of Disease Program, International Health Policy Program, Thailand (IHPP)
SSB Interventions
5.9
22.0
33.4
47.252.6
58.7
25.6
2.0
11.7
32.1
49.5
60.1
68.9
23.9
4.0
16.4
32.7
48.4
56.864.9
24.7
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
15-29 30-44 45-59 60-69 70-79 ≥80 รวมทกกลมอาย
%ชาย หญง รวม
ฉบบราง วชย เอกพลากร และคณะ
Prevalence of Hypertension (BMI ≥ 25 kg/m²) in Thai population
NHES IV 2009 NHES V 201421.4% 24.7%
Awareness and Controlled of Diabetes and Hypertension
20142014 20092009 20042004
UnDxUnDx
ControlledControlled
Salt & High blood pressure
Variety of Salt in Thai Cuisine
Global Framework: Action to Improve Response to Chronic Disease
•Painful facts of NCD
•Global NCD targets for 2025
•Political Economy of NCD
• Integrated People-Centered Health Services
•Expanded Chronic Care Model
WHO Framework for Integrated People-Centred Health Services
WHO (2015) WHO global strategy on integrated people-centred health services 2016-2026 Executive Summary
WHO Framework for Integrated People-Centred Health Services
Source: WHO (2015) WHO global strategy on integrated people-centred health services 2016-2026 Executive Summary
Chronic Care Team
• MD- managed medical aspect of care, medications and arranged for medical follow-up
• Social Worker- developed strategy for discharge to bridge community resources (VNS,
MOW), enlisted family support
• Physical Therapist- assessed falls risk gait/station developed plan for strengthening LE and
maintenance
• Occupational Therapist- assessed ADLs, provided equipt for home use
• Pharmacist- assessed meds for potential interactions, provided mediset
• Nurse- homecare visit to f/u sx, phlebotomy, fill medisets and evaluate compliance,
communicate with PCP and rest of care team
Chronic Care Model: The Evidence
• DM Improved measures of disease control (HgA1C)
• CHF Decreased hospitalizations/Cost of care
• Warfarin Clinic for long term anticoagulations
• Asthma Decreased hospitalization/cost
Global Framework: Action to Improve Response to Chronic Disease
• Painful facts of NCD
• Global NCD targets for 2025
• Political Economy of NCD
• Integrated People-Centered Health Services
• Expanded Chronic Care Model
Global Framework: Action to Improve Response to Chronic Disease
•Painful facts of NCD
•Global NCD targets for 2025
•Political Economy of NCD
• Integrated People-Centered Health Services
•Expanded Chronic Care Model