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Morbidity in Primary Care Dr. Abdul Sattar Khan MBBS, MPH, MCPS, DCHM, MRCGP (UK), FRIPH (UK) Assistant Professor Family Medicine Department [email protected] Can we measure diseases? Objectives At the end of the session, the students will be able to: • Understand the concept of morbidity • Know the definition of incidence & prevalence • Explain the current status of expertise in family medicine in Turkey • Explain why is a different pattern of morbidity in the practice of family medicine • Count common diseases • Advocate the importance of family medicine expertise in health care 3 Definition the discipline that applies • Morbid: Morbidity: Morbidity Rate: mathematical and statistical methods to assess risk • Morbidity (from Latin morbidus, meaning "sick, unhealthy") is a diseased state, disability, or poor health due to any cause. • In epidemiology and actuarial science, the term morbidity rate can refer to either the incidence rate, or the prevalence of a disease or medical condition.. 4 Measures of Disease Frequency Prevalence Rate Incidence rate Types of Fractions Used in Describing Disease Frequency • Ratio- A fraction in which….. the numerator is not part of the denominator. e.g. Males & Female Ratio in the class • Proportion- A fraction in which….. the numerator is part of the denominator. e.g. Fetal Death in the community: Fetal deaths/all births • Rate- A proportion in which….. change over time is considered e.g. Infant Mortality Rate: Infant deaths/live births (17/1000 live births) Prevalence rate 1. Point prevalence rate Proportion of individuals in a specified population at risk who have the disease of Interest at a given point in time. (when the type of prevalence rate is not specified it is usually point prevalence) 2. Period prevalence rate • Proportion of individuals in a specified population at risk who have the disease of interest over a specified period of time. • For example: annual prevalence rate, lifetime prevalence rate. Incidence rate 1. Cumulative incidence rate Number of new cases of disease occurring over a specified period of time in a population at risk at the beginning of the interval. 2. Incidence density Number of new cases of disease occurring over a specified period of time in a population at risk throughout the interval. Health Transformation Program in Turkey by Ministry of Health New era in primary health care: Family medicine 14 Primary health care is on the rise 8000 7000 6000 5000 4000 PHC centres 3000 2000 1000 0 PHC centres 1 1996 4791 2 002 5055 3 2009 7216 Number of Active Primary Health Care The Ministry of Health of Turkey Health Statistics Yearbook - 2008 15 Referral Rate drop 25 1996 20 2002 15 Rate of referral 10 5 2009 0 Referral Rate from Primary Health Care to Secondary care The Ministry of Health of Turkey Health Statistics Yearbook - 2008 16 EUROPEP Scale Satisfaction Survey in 81 provinces for 2009 Overall satisfaction level of our citizens with primary health care in the provinces where family medicine has been launched is around 83%. The Ministry of Health of Turkey Health Statistics Yearbook - 2008 17 Common problems encounter at primary health care 1. 2. 3. 4. 5. 6. 7. 8. High Blood Glucose High Blood Pressure High cholesterol Arthritis Depression Low back pain Fatigue Impaired memory 9. 10. 11. 12. 13. 14. Anxiety Eating disorders Obesity STI Headache Conjunctivitis 18 Distribution of Hospital Discharges by ICD-10 Main Diagnosis Codes and Gender, (%), Turkey, 2008 Code Female Male Total Infectious and Parasitic A00 B99 2.7 4.0 3.2 Neoplasm C00 D49 5.0 7.1 5.9 Blood & Immune mechanism D50 D89 1.3 1.3 1.3 Endocrine, Nutritional and Metabolic E00 E99 3.3 2.4 2.9 Circulatory system 100 -199 7.8 13.5 10.2 Respiratory system J00 J99 8.4 15.0 11.2 Digestive system K00 K99 6.9 10.1 8.3 ICD10 Diagnosis Codes The Ministry of Health of Turkey Health Statistics Yearbook - 2008 19 Why primary care? 20 System characteristics • Better health outcomes • Lower costs • Greater equity in health 21 Practice Characteristics • • • • • • First-contact Longitudinality Comprehensiveness Coordination Family-centeredness Community orientation 22 Summary • Define morbidity? • Can you count 10 most common problems encounter at PHC? • Is is important to have primary care ? • What is patient-centered approach? 23 Thanks Teşekkürler 24