ACTION GROUP A1 PRESCRIPTION AND ADHERENCE TO TREATMENT

Transcription

1 ACTION GROUP A1 PRESCRIPTION AND ADHERENCE TO TREATMENT COMMITMENTS OF THE BASQUE COUNTRY 1 JUNE 2013

2 OUTLINE OBJECTIVES COMMITMENTS INSTRUMENTAL PROJECTS DELIVERABLES: OBJECTIVE 2. Empower the patients and care givers ACTION AREA: EDUCATION Expert Patient Programme for type 2 diabetic patients Implementation of a personal health folder and other online health services Programme for primary prevention of diabetes type 2 through changes in lifestyle implemented by primary care professionals (D-Plan) ACTION AREA: SOCIAL NETWORK (Development of a) Social network for patients with chronic conditions, their relatives and caregivers OBJECTIVE 3. Deliver improvements in the health care system ACTION AREA: ELECTRONIC PRESCRIPTION Implementation of the electronic prescription in the Basque Country OBJECTIVE 4. Research and methodology ACTION AREA: EVIDENCE Evaluation of the effectiveness of the Expert Patient Programme for type 2 diabetic patients Review of medication and patient education on type 2 diabetes Polymedicated patients pilot project Evaluation of the effectiveness of a programme for primary prevention of diabetes type 2 through changes in lifestyle implemented by primary care professionals (described in the Education section) 2

3 OBJECTIVES Promote healthy habits in population at risk Increase patients confidence, skills and knowledge Ensure safety and adherence to drugs and medical plan 3

4 COMMITMENTS 1.Design, development and implementation of evidence based interventions towards health promotion and prevention of chronic illnesses. Starting with Type 2 Diabetes, a reduction in the risk of developing chronic illness is sought introducing healthier diet habits, physical exercise and other healthy lifestyles 2.Enhance self-care and adherence to healthy lifestyles and treatment fostering active patients. Promote an active role of citizens in dealing with chronicity, enabling patients and professionals to be trainers of their peers 3.Adherence to intervention plans drawn on risk level. Development of personalised care plans and organizational changes. Implementing new information tools, such as the Personalized Drug Schedule of Electronic Prescription, in the Patient Personal Health Folder, enhancing long term adherence to medical plans 4

5 INSTRUMENTAL PROJECTS Telematic Health counselling and Personal Health Folder Promotion of healthy lifestyles Intervention (D-Plan) Expert Patient Chronic Disease Self-Management Program Electronic prescription Polymedication project 5

6 DELIVERABLES Expert Patient Programme for type 2 diabetic patients Implementation of a personal health folder and other online health services Programme for primary prevention of diabetes type 2 through changes in lifestyle implemented by primary care professionals (and its evaluation) (Development of a) Social network for patients with chronic conditions, their relatives and caregivers Implementation of the electronic prescription in the Basque Country Evaluation of the effectiveness of the Expert Patient Programme for type 2 diabetic patients Review of medication and patient education on type 2 diabetes Polymedicated patients pilot project 6

7 OBJECTIVE 2. EMPOWER THE PATIENTS AND CARE GIVERS ACTION AREA: EDUCATION Expert Patient Programme for type 2 diabetic patients Implementation of a personal health folder and other online health services Programme for primary prevention of diabetes type 2 through changes in lifestyle implemented by primary care professionals (D-Plan) ACTION AREA: SOCIAL NETWORK (Development of a) Social network for patients with chronic conditions, their relatives and caregivers 7

8 EXPERT PATIENT PROGRAMME FOR TYPE 2 DIABETIC PATIENTS Active Patient Programme : an expert patient programme based on Stanford Chronic Diseases and Diabetes Self- Management program. Target population: 500 patients (pilot); 3,000 'activated' by the end of 2014 Diabetic (type 2) patients Starting date: 2011 Status: ongoing Main Outcome: Evaluate the effectiveness of the "Diabetes Self-Management Programme" (DSMP) on the metabolic control, cardiovascular risk reduction, quality of life and selfefficacy in adult patients with type 2 diabetes, compared with current standard care of patients with type 2 diabetes, in the context of the Primary Care network of the Basque Health Service. 8

9 IMPLEMENTATION OF A PERSONAL HEALTH FOLDER AND OTHER ONLINE HEALTH SERVICES PHF: Contains all the patient clinical information including care plans, pharmacotherapeutic plans and relevant information for citizens Target Population: Total population around 2,200,000 Progressive extension to the whole Basque population Status: implemented First version released by October 2012 (pilot on 500 users) Second version released by December 2012 Regular updates with progressive deployment of services during 2013 Main Outcome: Improved access to his/her own health information by the citizen and improved interaction between users and health professionals. It will contribute to the population's health empowerment and capacity to self-care. It will also contribute to the coordination of care, though the access to more complete information on the patients' health and healthcare by different health provider/professionals. 9

10 PROGRAMME FOR PRIMARY PREVENTION OF DIABETES TYPE 2 THROUGH CHANGES IN LIFESTYLE IMPLEMENTED BY PRIMARY CARE PROFESSIONALS (D-PLAN) Target Population: 1,008 patients years old patients, without diabetes, but in high risk of developing DM type 2 (FINDRISC score higher than 14), consulting primary care Educational intervention programme consisting in 4 group sessions dealing with the modification of unhealthy habits. Starting date: 2011 Deadline: 2013 Status: ongoing Main Outcome: Improving adherence to healthy habits by patients at risk of developing a chronic condition such as diabetes mellitus type 2. Through this change of habits, it is expected to reduce diabetes risk by 35% in the intervention group versus the control group. 10

11 SOCIAL NETWORK FOR PATIENTS WITH CHRONIC CONDITIONS, THEIR RELATIVES AND CAREGIVERS Target Population: 1,000 users currently. The target for 2013 is 5,000 users. Persons with chronic conditions, their relatives and caregivers Starting date: April 2012 Status: ongoing Main Outcome: Improve the quality of life of persons living with chronic conditions, their relatives and caregivers, through the development of relationships that provide emotional support and empower them to better deal and live with their conditions. 11

12 OBJECTIVE 3. DELIVER IMPROVEMENTS IN THE HEALTH CARE SYSTEM ACTION AREA: ELECTRONIC PRESCRIPTION Implementation of the electronic prescription in the Basque Country 12

13 IMPLEMENTATION OF THE ELECTRONIC PRESCRIPTION IN THE BASQUE COUNTRY Target Population: Whole Basque population. Persons with chronic conditions, their relatives and caregivers Starting date: 2011 Deadline: 2013-Q4 Status: implemented across all primary healthcare centres Main Outcome: It will boost the safe and efficient use of medicines. It will contribute to: improve the quality of the pharmaceutical provision, enhance knowledge by the patient about his/her treatments, improve safety in the use of medicines, and contribute to sustainability of the healthcare system. 13

14 OBJECTIVE 4. RESEARCH AND METHODOLOGY ACTION AREA: EVIDENCE Evaluation of the effectiveness of the Expert Patient Programme for type 2 diabetic patients Review of medication and patient education on type 2 diabetes Polymedicated patients pilot project Evaluation of the effectiveness of a programme for primary prevention of diabetes type 2 through changes in lifestyle implemented by primary care professionals (described in the Education section) 14

15 EVALUATION OF THE EFFECTIVENESS OF THE EXPERT PATIENT PROGRAMME FOR TYPE 2 DIABETIC PATIENTS Target Population: Diabetic (type 2) patients Starting date: 2011 Deadline: 2014-Q4 Status: by June 2013, 107 courses delivered with 1297 patients and carers trained Evaluation: RCT of a sample of 556 patients commenced (results of the pilot project and now analysing the 6 month s results) Main Outcome: (pilot project- basal vs 6 months) In a sample size of 171 patients, statistically significant results are found in the following parameters: Arterial pressure is lowered (SAP p=0,002, DAP p=0,022) Percentage of patients performing recommended physical activity is increased Percentage of patients eating recommended fruit and vegetable amount is increased (p=0,029) Self-efficacy is increased (p= <0,0001) General practitioner consultation and nurse consultation is decreased in 1 visit Patients show high satisfaction levels 15

16 REVIEW OF MEDICATION AND PATIENT EDUCATION ON TYPE 2 DIABETES POLYMEDICATED PATIENTS PILOT PROJECT Target Population: Whole Basque population. Persons with chronic conditions, their relatives and caregivers Starting date: 2011 Deadline: 2013-Q4 Status: implemented in 100% of the primary care health centers included in the pilot phase, showing a satisfactory patient inclusion evolution. Main Outcomes: Preliminary results indicate that the pharmacotherapeutic intervention has an impact on reducing the number of drugs that patients are prescribed and especially in those patients whose degree of polypharmacy is 9 or more medications. Likewise it has been observed that adherence of intervention group patients relevantly improved (from 71% to 97.8%). An improvement in the perception of the quality of life of patients in the group compared to the control intervention has also been observed 16

17 17