Implementation of social security chronic disease management program in yogyakarta

Elderly is a global concern since the number of elderly populations is increasing, which also become one of the concerns of the national health insurance (JKN). Health insurance for the elderly has a package of benefits according to physical conditions and degenerative diseases. Since the elderly is susceptible to disease, Indonesia has Healthcare and Social Security Chronic Disease Management Program, National Health Insurance known as Badan Penyelenggara Jaminan Sosial Program Pengelolaan Penyakit Kronis (BPJS Prolanis) to guarantee the health of elderly. This study aims to obtain an overview of the implementation of BPJS Prolanis in the community which located in Yogyakarta in order to give the feedback for this program. This research using qualitative method, with phenomenological research approach, which conducted in Yogyakarta during 2020. The result showed that most of the elderly, which is 221 (77.5%) elderly already have the health insurance, but only 38.9% who has BPJS Prolanis. Besides, there are more than 50% of the elderly have disease that often complained of. Hence, this study proposed suggestions for BPJS Prolanis, such as giving a continues education for the elderly through public health center. Besides, public health center can hold a promotive and preventive activities for the elderly to increase the awareness of the elderly on having the BPJS Prolanis.

Benefits of a Disease Management Program for SCD in Germany 2011 - 2019: The Increased Use of Hydroxyurea Correlates with a Reduced Frequency of Acute Chest Syndrome

Background Worldwide, Sickle Cell Disease (SCD) is the most common single gene disorder affecting >250,000 newborns annually. In Germany, SCD qualifies as a rare disease and almost exclusively affects immigrants from endemic countries and their descendants. The recent surge of immigration from high-prevalence countries increased the numbers of patients with SCD in Germany and raised awareness for the need of specialized care. In 2012, the German Society for Pediatric Oncology and Hematology (GPOH) mandated a consortium of five university hospitals to develop a disease management program for patients with SCD. This consortium issued treatment guidelines for SCD that strongly favor the use of hydroxyurea, initiated patient and physician education events, prepared for a universal newborn screening program that will start 09/2021, moderated a consensus on the indication of allogeneic stem cell transplantation for patients with SCD, and established a national patient registry. Methods In order to quantify the effect of these activities, we made use of claims data that were collected by the research institute (WIdO) of the major German insurance company, the Allgemeine Ortskrankenkasse (AOK), and of publicly accessible data collected by the Federal Statistical Office (Statistisches Bundesamt, Destatis). ICD10 codes were used to identify patients with SCD and their comorbidities. Pharmacologic treatments were quantified using the German Anatomical Therapeutic Chemical (ATC)-Classification with defined daily doses. Results We estimate that the number of patients with SCD in Germany increased from approximately 2,200 in 2011 to approximately 3,200 in 2019. Analyses of administered treatments illustrate that important components of recently issued national treatment guidelines have been largely implemented. Specifically, the use of hydroxyurea has more than doubled, resulting in a proportion of approximately 45% of all patients with SCD being treated with hydroxyurea in 2019 (Figure 1A). In strong negative correlation with the use of hydroxyurea, the frequency of acute chest syndromes decreased (Figure 1B). While before the widespread use of hydroxyurea (2011-2013) 8.1% of patients with SCD were admitted at least once per year for ACS, this proportion dropped to 6.6% in the period 2017 to 2019. Similarly, the proportion of patients who required analgesics, red blood cell transfusions and hospitals admissions declined from 2011 to 2019, indicating a reduced burden of SCD with the increased use of hydroxyurea. Conclusion In sum, these data demonstrate an association between the dissemination of nationwide treatment guidelines and changes in clinical practice in particular relating to the use of hydroxyurea. These changes translate into a remarkable improvement of key measures of disease activity in a representative population based analysis. Figure 1 Figure 1. Disclosures Lobitz: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; AddMedica: Honoraria, Membership on an entity's Board of Directors or advisory committees; Vertex: Honoraria, Membership on an entity's Board of Directors or advisory committees. Kulozik: BioMedX: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sanofi: Consultancy, Honoraria; bluebird bio, Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Benefits of a Disease Management Program for Sickle Cell Disease in Germany 2011–2019: The Increased Use of Hydroxyurea Correlates with a Reduced Frequency of Acute Chest Syndrome

Sickle Cell Disease (SCD) is the most common monogenic disorder globally but qualifies as a rare disease in Germany. In 2012, the German Society for Paediatric Oncology and Haematology (GPOH) mandated a consortium of five university hospitals to develop a disease management program for patients with SCD. Besides other activities, this consortium issued treatment guidelines for SCD that strongly favour the use of hydroxyurea and propagated these guidelines in physician and patient education events. In order to quantify the effect of these recommendations, we made use of claims data that were collected by the research institute (WIdO) of the major German insurance company, the Allgemeine Ortskrankenkasse (AOK), and of publicly accessible data collected by the Federal Statistical Office (Statistisches Bundesamt, Destatis). While the number of patients with SCD in Germany increased from approximately 2200 in 2011 to approximately 3200 in 2019, important components of the recently issued treatment guidelines have been largely implemented. Specifically, the use of hydroxyurea has more than doubled, resulting in a proportion of approximately 44% of all patients with SCD being treated with hydroxyurea in 2019. In strong negative correlation with the use of hydroxyurea, the frequency of acute chest syndromes decreased. Similarly, the proportion of patients who required analgesics and hospitals admissions declined. In sum, these data demonstrate an association between the dissemination of treatment guidelines and changes in clinical practice. The close temporal relationship between the increased use of hydroxyurea and the reduction in the incidence of acute chest syndrome in a representative population-based analysis implies that these changes in clinical practice contributed to an improvement in key measures of disease activity.

Efficacy and Outcomes of a Novel Telephone-based Gout Disease Management Program

Objective: Gout is the most common inflammatory arthritis in the United States. Despite published guidelines, management remains suboptimal, leading to unnecessary morbidity and increased cost of care. We have designed the gout disease management program (GDMP) to improve outcomes, increase patient satisfaction, and decrease healthcare utilization. Methods: Gout patients were seen at their usual rheumatology clinical visit and offered participation in the GDMP. Data were collected between April 2017 and November 2019. Serum uric acid (SUA) levels were measured at the initial outpatient encounter, at the entrance to GDMP, and every 4 weeks until SUA was at the goal of ≤6 mg/dl. Through telephonic encounters, gout-related recent hospitalizations, and ER or urgent care visits since the last encounter were ascertained. Self-reported gout medication usage and adherence were also determined. Patient satisfaction with GDMP was surveyed using a 5-point Likert scale. Results: A total of 158 patients were enrolled, of which 112 had ≥ 1 telephone encounter and were included in our analyses. During the telephone phase, 79 patients (70%) achieved the SUA goal of ≤6.0 mg/dl. Only 3 patients (2.6%) required hospitalization or visits to an ER or urgent care center due to gout flare, and 98% rated their encounter as a 5 on the 5-point Likert scale. Conclusion: Our telephone-based management program for gout led to improved clinical outcomes as defined by the ACR guidelines, decreased healthcare visits, and had high patient satisfaction. Significance and Innovations: • First telephone-based, rheumatology providers-led study to manage gout • Additional evidence to confirm the feasibility and benefit of telemedicine in common diseases • First study to show excellent patient satisfaction

Prevalence of comorbidities associated with type 2 diabetes in patients attending a disease management program, Medellín, Colombia 2014 - 2019: a descriptive study.

Background: Type 2 diabetes is a significant cause of morbidity and mortality worldwide. The prevalence has increased due to population aging, obesity, and longer life expectancy. Likewise, the development of complications related to the disease has contributed to a more significant disease burden and is the leading cause of death in people with diabetes. Methods: A descriptive study of patients in a disease management program in Medellín, Colombia, from June 10, 2014 to March 30, 2019 was carried out. Sociodemographic and clinical data were collected from clinical records. Descriptive analysis was performed using absolute and relative frequencies and the prevalences presented by sex. The Chi-square test was used to calculate the prevalence ratio with a 95 % confidence interval, with a p-value < 0.05 being considered statistically significant. Results: There were 1,018 patients with type 2 diabetes analyzed. The mean age was 66.0 years (SD: 12.93), the mean duration with diabetes was 12.9 years (SD:9.3), 55 % of patients were women, and 60.6 % of patients had no metabolic control. The main comorbidities were dyslipidemia in 67.9 %, obesity in 61.4 %, and hypertension in 59 % of patients. Differences were observed in the prevalence ratio (PR) of women versus men for dyslipidemia (PR 0.68 [CI: 0.52 - 0.89]), coronary artery disease (PR 0.41 [CI: 0.28 - 0,61]) and obesity (PR 0.23 [CI: 0.17 - 0.30]). Conclusions: Patients with type 2 diabetes have a high prevalence of comorbidities: dyslipidemia, obesity and arterial hypertension. A lower prevalence of comorbidities was observed in women than men for dyslipidemia, coronary heart disease, and obesity.