WCPD10 Edinburgh 15 th 18 th July 2018 Pirjo Ilanne-Parikka
Pirjo Ilanne-Parikka MD, PhD, Diabetologist Physician in Chief, Finnish Diabetes Association Project manager, Diabeteshub, Health Village in Virtual Hospital 2.0 Private practitioner
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5.5 million inhabitants Helsinki Capital region 1.4 million 338 423 km 2 ~ 450 000 persons with diabetes 378 337 used diabetes medication at year 2017 ~ 50 000 type 1diabetes Gestational diabetes 15.6 % 5 university hospitals 21 hospital districts 142 independent municipality based primary health care centres Occupational health care Private sector 4
Diabetes Prevention Study (DPS) in Finland DEHKO National Programme for the Prevention and Care of Diabetes in Finland 2000 2010 Programme for the Prevention of Type 2 Diabetes in Finland FIN-D2D Project: Implementation of Type 2 Diabetes Prevention Plan 2003-2007 5
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The intensive lifestyle intervention in individuals with IGT was most effective among those with higher baseline age or a high FINDRISC. To improve costeffectiveness, the FINDRISC could be used to identify target groups for lifestyle intervention to prevent type 2 diabetes. 18
Paper copies delivered Year 2015: 114 000 Year 2016: 61 243 Year 2017: 42 823 Net calculator at the web site of Finnish Diabetes Association 4/2017 5/2018: 227 000 A part of regular (occupational) health check-ups Widely promoted at pharmacies 19
Take Action Prevent type 2 diabetes GOAL One-Life collaboration 20
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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 National insurance institution Kela www.kela.fi 20 000 20 000 18 000 18 000 16 000 14 000 12 023 16 000 14 000 12 000 10 000 11 338 12 000 10 000 9 461 9 716 8 000 8 000 6 000 6 000 4 000 4 000 2 000 2 000 0 0 24
Finnish Diabetes Associaton Finnish Heart Association Finnish Brain Associaton 25
One Life is a joint action on Finnish Diabetes Association, Finnish Heart Association and Finnish Brain Association to promote vascular health and well-being The main objectives of One Life are: to promote life-long health to prevent vascular diseases and promote early diagnoses to make rehabilitation and peer support an integral part of good care To promote versatile health communication and awareness raising 26
https://www.sydanmerkki.fi/en The Heart Symbol tells the consumer at a glance that the product marked with this symbol is a better choice in its product group regarding fat and salt. In some product groups, also sugar and fibre contents are taken into account. 1. milk and dairy products 2. oils and fats 3. fish 4. meat 5. meat products 6. bread and cereal products 7. convenience foods 8. spices and seasoning sauces 9. vegetables, fruits and berries 28
https://www.sydanmerkki.fi/en/criteria-for-healthy-lunch Brand awareness 81,9 %, among female 91,1%, men 69,5 % Use of products with Heart Symbol 65,9 %, among female 73,9 %, men 54,8 % The 22nd most valued brand in Finland. Total amount of different products is over 1200 Food industry companies using Heart Symbol in their products 123 Restaurants serving Heart Symbol meals over 300 29
The Small Decision a Day project offers support, ideas and advice on how to adopt a healthier lifestyle. Small decisions people have made: I will go to bed at 11 o clock pm I will hug my wife / husband every day I will go out for a walk three times a week I will use stairs instead of lift www.pienipaatospaivassa.fi www.facebook.com/pienipaatospaiv assa
The Smart Families project provides health guidance for families. Discussing lifestyle choices is made easier. Guidance is more detailed and personal. Family members take an active role in shaping their health. The project was launched in 2006 as a part of the programme 'Finnish Heart Plan'. Drawing by Annika Mannström
Keys to your health project provides tools for motivational lifestyle coaching. It provides ideas and tools for creating and implementing a lifestyle change plan. It builds on the client's personal needs and abilities. It is particularly well suited to coaching people who belong to a risk group or suffer from obesity or an chronic disease.
The D-Academy Diabetes is a constantly evolving condition; the more information people have, the better they can prevent and treat it. Online courses for persons with diabetes D-Academy year 2017: 4 different platforms Type 1 diabetes Type 2 diabetes For those with risk or with gestational diabetes After gestational diabetes 15 online courses 539 participants
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National nutrition recommendations 2014 and Healthy Nordic Diet One Life collaboration -> NCD Alliance in Finland VESOTE program 36
www.evira.fi/en/foodstuff/healthy-diet/nutritionrecommendations-for-all 37
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UKK Institute Promoting Health-enhancing Physical Activity VESOTE is a programme in one of the governments key projects: Promoting health and well-being, reducing inequality and putting good practices into permanent use. Reinforces and develops effective and target-based lifestyle counselling in social and health care. The final goal of the program is for Finns to be more physically active sit less eat a varied and healthy diet sleep better. http://www.ukkinstituutti.fi/en Director, UKK Institute tommi.vasankari(a)uta.fi 40
UKK Institute Promoting Health-enhancing Physical Activity Activities Regional and web-based training for professionals: - bringing up the topic of lifestyle behaviours - counselling on physical activity, nutrition, sleep and treatment of sleep disorders without medication. Developing and reinforcing treatment and service chains. Creating regional co-operation networks. Objective monitoring of physical activity and sleep, as well as utilising information in lifestyle counselling. Assessing the effectiveness of lifestyle counselling. 41 http://www.ukkinstituutti.fi/en
FinHealth Study 2017 StopDia Study Digital infrastructure development Social- and healthcare reform in Finland 42
www.thl.fi/en/ 9 345 randomly selected persons > 30 years Participation 70,5 % Men (%) Women (%) Overweight (BMI 25) 72 63 Obese (BMI 30) 26 28 Central obese (waist > 100 / 90 cm) 46 46 At high risk for T2D (Findrisk 12) 23 28 Persons with diabetes (30+ years) 15 9 Diagnosis known 12.6 8.6 Diagnosis unknown 3.1 1.4 https://thl.fi/en/web/thlfi-en/research-and-expertwork/population-studies/national-finhealth-study 43
www.thl.fi/en/ 10 000 randomly selected persons > 18 years Participation 69 % -> 7055 persons participated Men (%) Women (%) Persons with diagnosed diabetes 15 9 Blood glucose measured 6 month 68 72 Using diabetes medication 93 89 HbA1c < 53 mmol/mol 73 70 https://thl.fi/en/web/thlfi-en/research-and-expertwork/population-studies/national-finhealth-study 44
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Academy of Finland Strategic Research Council 2016-2019
to develop and test a dual process approach model to support health promoting behavior at individual level and by modifying living environment to identify societal key barriers and facilitators of healthy lifestyle.
WP1: Principal investigator, general management, Jussi Pihlajamäki, (UEF) WP2: Behavior change at individual and environmental level, Pilvikki Absetz, (UEF) WP3: Identification of individuals at increased risk of T2D, Jaana Lindström (THL) WP4: Digital solutions to support individuals in healthy lifestyle, Marja Harjumaa (VTT) WP5: Individual level intervention, Timo Lakka (UEF) WP6: Environmental intervention to support healthy lifestyle, Kaisa Poutanen (VTT) WP7: Socio-economic barriers and facilitators to support decision making, Janne Martikainen (VTT) Coordinator Tanja Tilles-Tirkkonen (UEF) 48
Kanta -services My Health services and Virtual Hospital 49
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MyHealth Digital well-being services and selfcare: 51
AVAILABILITY CUSTOMER TIME MANAGEMENT AND COSTS QUALITY
Hospital District of Southwest Finland (VSSHP) Northern Ostrobothnia Hospital District (PPSHP) Turku Tampere Helsinki Oulu Kuopio Hospital District of Northern Savo (PSSHP) Pirkanmaa Hospital District (PSHP) Hospital District of Helsinki and Uusimaa (HUS) All Finns under university hospital districts. Functionality, availability and seamlessness of services on a national level. Funding from the Ministry of Social Affairs and Health.
Service production and implementation Service packages for selected, nationally significant patient groups Sorted by symptom/disease; Information and advisory services Self-care services Symptom navigators, advice barometers Integrated services and applications for treatment paths Professionals tools Communication to citizens Innovation farm Innovation workshops Technology scan Piloting and testing Artificial intelligence, IoT, big data International and national cooperation Research, impact and evaluation Research cooperation and programmes Validation Researchers tools and data analysis competence Development of services and change of operation Development model Resourcing and networking of developers Expertise hubs
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FOR PROFESSIONALS Remote appointments econsultations Diagnosis tools DIGITAL SERVICES AS A PART OF PATIENTS TREATMENT PATH Support/coaching therapy/remote treatment Unique care plan for patient to inspect Communication Symptom barometer Personal path customer account Self-care/ self-monitoring Applications Devices, instruments Treatment instructions in digital format Applications/ sensors Researchers' tools SERVICES AVAILABLE FOR CITIZENS Examination consent Identification Information and advice services Engagement Peer support Service presentations Symptom-specific barometers Service guidance Self care services
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DPS and the follow-up study T2D prevention programme and D2D implementation Findrisk Diabetes matters Collaboration for vascular health Heart symbol and Healthy Nordic diet Health Village Real life implementation Continuity Systematic quality assessment How to reach and engage right people Programme adherence vs. personalized Gestational diabetes Service reform - responsibilities 59
Thank you! Pirjo.ilanne-parikka@diabetes.fi www.diabetes.fi