Diabetes Screening and Risk Factors Safe Smart Screening

Diabetes Screening and Risk Factors: Safe Smart Screening (SSS) Dr Samya Ahmad Al Abdulla

I, Dr. Samya Ahmad Al Abdulla DO NOT have actual or potential conflict of interest in relation to this presentation.

Population Health Screening in Qatar The QNHS is based on the Triple Aim of Better Health, Better Care, Better Value. Triple Aim will include life expectancy, years of potential life lost, disease burden (the incidence and/or prevalence of chronic disease), hospital utilization rates, clinical quality measures and cost.

A robust situational analysis including review of data, patient feedback and staff opinion determined current and desired future states: FROM TO Undiagnosed diabetes; little identification of pre-diabetes Patient identification All those with diabetes or pre-diabetes identified Fragmented lists of diabetes patients Registry Single, shared registry of target cohort No systematic care plans for patients Inconsistent care pathways Various KPIs monitored separately across organisations Care Plans Pathways KPIs Individual plans for all those with diabetes or pre-diabetes Clearly defined pathways Agreed KPIs monitored consistently across organisations

Why Diabetes - what is the significance for Qatar? ü Four out of ten adults with diabetes in the Middle East and North Africa are undiagnosed. ü The estimate in 2015 is that 17% of the adult population in Qatar, or about 85, 000 individuals, have diabetes compared to 8% of the global prevalence (IDF, 2014 -1)

Additional Health Risk Factors CVD: ü An estimated 17. 7 million people died from CVDs in 2015, representing 31% of all global deaths. Of these deaths, an estimated 7. 4 million were due to coronary heart disease and 6. 7 million were due to stroke. Mental Health: ü 1 in 5 people are affected by depression and anxiety at some point in their lives (10% of world population). Obesity: ü In the MENA region 73% of females and 69% of males are classified as obese (BMI ≥ 30) ü Depression increases the risk of NCDs and impacts effectiveness of NCD treatment. ü Qatar has the 6 th highest rate of obesity among males in the MENA region Source: WHO (2015) ü These diseases have remained the leading causes of death globally in the last 15 years, and they are the leading causes of death in High income economies. Source: WHO (2015) ü Lack of treatment for common mental disorders has a high economic cost. ü The most common mental health disorders can be prevented and treated at relatively low cost if screened and identified early.

Primary Care based screening model The primary objective of the SMART Health screening is to act as a gateway into the full range of primary health care services and support the population of Qatar to take steps to maintain or improve their health. Priority patients are identified and invited to screen and their risk stratification assessed. Management / treatment plans are set up based on individualized care needs

The Comprehensive SMART Health Checkup Assessment Appointment – What the nurse does: ü Vital signs (BP, weight, height, waist circumference, temp) and ECG. ü Assessment: personal medical history (incl. mental health screening); family medical history; social history. ü Lab orders include: CBC, CMP, Hb. A 1 c, Thyroid Function Test (TSH) and Lipid Panel (non-fasting) SMART Health Checkup Consultation Appointment – What the physician does: ü Review the information obtained in the checkup assessment and lab results. ü Perform a physical examination. ü Explain to the patient their health status. ü Determine what health care needs the patient has and develop a personalized care plan to meet the identified needs. ü Provide any necessary counselling, treatment, referrals or further investigations.

Key findings Blood Pressure Results for SMART HC Patients 29. 2 70. 8 BP Normal Cholestrol results for SMART HC Patients 9% 26% 65% Optimal- Cholestrol <5. 2 Intermediate- Cholestrol 5. 2 -6. 2 High- Cholestrol >6. 2 BP Elevated

The Comprehensive SMART Screening – Hb. A 1 c pathway Hb. A 1 c Result explained by physician Non-diabetic Hb. A 1 c ≤ 5. 6% PHCC Provide educational advice and leaflets Recall patient for rescreening after one year Pre-diabetic HBA 1 c 5. 76. 4% PHCC Provide educational advice and leaflets Personalised Care Plan Diabetic Hb. A 1 c ≥ 6. 5% PHCC Provide educational advice and leaflets Personalised Treatment Plan

In summary, the purpose of the SMART Screening includes: • Identify and understand community health priorities through engaging and screening the population • Support future strategic forecasting, including expenditure and health outcomes • Initiate personalized treatment and maintenance measures to reduce the burden and cost of disease on the health system • Improve health outcomes for the community by reducing morbidity • Encourage co-ordination of care between providers • Integrate care with other locally relevant strategic priorities