Ministerio della Salute Roma, October 2014

Europe GARD Country activities and National Action Plans against CRD

- Portugal -

J. Rosado Pinto GARD Portugal Coordinator

PORTUGAL

Population- 10.600.000inh

GDP per capita - 23.800$

Life expectancy – Female 82,9 | Male 76,9

Healthy life expectancy at birth - 71y

Neonatal mortality rate/ 1000 live birth: 1,8

Safest countries for new borns – 10th

Life expectancy at birth among women – 10th

Rating UNDP Report (2014) – 41º

LEADING CAUSES OF DEATH IN PORTUGAL

Source: INE, IP, 2013

Cancer

Cardiovascular diseases

Respiratory diseases

YEAR

31%

25%

12%

Cancer

Cardiovascular diseases

Respiratory diseases

Cardiovascular Diseases

Diabetes

Respiratory Diseases

Infectious and Parasitic Diseases

AIDS

Cancer

Injuries and Poisoning

Digestive Diseases

Tuberculosis

Suicide

LEADING CAUSES OF HOSPITAL DEATH, PORTUGAL (2012)

Source: GDH´s- ACSS/DGS, 2013

12803

10231 9820

3613

428

0

2000

4000

6000

8000

10000

12000

14000

D. AparelhoRespiratório

Neoplasias D. AparelhoCirculatório

D. AparelhoDigestivo

D. S. Nervoso

1st

2nd

3rd

4th

5th

Respiratory Cancer Cardiovascular Digestive system Nervous system Diseases Diseases Diseases Diseases

RESPIRATORY DISEASES STANDARDIZED MORTALITY

RATE/100 000 INHABITANTS

Source: INE, IP, 2014

500 474,3

452,3

522,5

100

300

500

2009 2010 2011 2012

(under 65 years) (65 or more)

8,5

7,2

7,5

6,2

0

2

4

6

8

10

2009 2010 2011 2012

Source: GDH´s- ACSS/DGS, 2013

LEADING CAUSES OF HOSPITAL ADMISSIONS, PORTUGAL (2012)

142767

130704

122714 120039 115145

0

20000

40000

60000

80000

100000

120000

140000

160000

D. AparelhoCirculatório

D. S. Nervoso Neoplasias D. AparelhoDigestivo

D. AparelhoRespiratório

1st

2nd

3rd

4th

5th

Cardiovascular Nervous system Cancer Digestive system Respiratory Diseases Diseases Diseases Diseases

ASTHMA and COPD National Programmes

2001 2005

PORTUGUESE NATIONAL PROGRAMME FOR RESPIRATORY DISEASES (PNDR 2012-2016)

ARIA, GINA, GOLD

1. Promote prevention, especially 2nd and 3rd, with specific plans for 100% of health regions.

2. Contribute to the early diagnosis, increasing accessibility to spirometry in 30% in Primary Health Care

3. Optimize the use of therapeutic devices (spacer devices) reducing by 30% the aerosol therapy

4. Improve the efficiency of prescribing, increasing to 50% via electronic prescribing Respiratory Home Care

5. Improve the accessibility of Respiratory Patients by implementing a referral network for Chronic Respiratory Disease (CRD)

6. Reduce hospitalizations for CRD in 10%

7. Reducing mortality from respiratory disease in 2%

CONDITIONS WITH HIGH PREVALENCE

• Asthma

• COPD

• Sleep Apnea

CONDITIONS NEEDING HIGH DIFERENTIATION

• Cystic Fibrosis

• Pulmonary Hypertension

• Interstitial Diseases

ASTHMA MORTALITY – PORTUGAL (RATE 100.000 INHABITANTS)

Morais-Almeida M, Fonseca J, Bugalho-Almeida A. Epidemiology Severe Asthma 2010

Male Female

ASTHMA National survey 2010

• Cumulative prevalence

Asthma …………………. 1080000 – 10,5% [9.5-11.6]

Rhinitis ………………… 2273000 – 22.1% [20.7-23.6]

Controlled Asthma … 57%

In the last year: 23% went to an

emergency room

3% were hospitalized (around 20500)

68%

had one or more medical appointment

34%

had no asthma medication adjustment

72% medication in the last 4 weeks 83% asthma diagnosed

ASTHMA National survey

ASTHMA, STANDARDIZED RATE OF HOSPITAL ADMISSIONS (/100 000) PORTUGAL/EU

Source: OECD, Health at a glance: Europe 2012

15.1

53.3

admissions

deaths

ASTHMA , EVOLUTION OF HOSPITAL ADMISSIONS AND MORTALITY – PORTUGAL

Source: ONDR 2013

800 000 pts

Source: Bárbara. Rev Port Pneumol. 2013; 19 (3): 96-105

COPD

Source: GDH´s- ACSS/DGS, 2013

COPD, EVOLUTION OF HOSPITAL ADMISSIONS, PORTUGAL (2007-2011)

25.6% > 1 admission

Patients discharged Patients discharged excluding ambulatory

Source: OECD, Health at a glance: Europe 2012

COPD STANDARDIZED RATE OF HOSPITAL ADMISSIONS, (/100 000) PORTUGAL /EU

71.3

183.9

COPD , EVOLUTION OF HOSPITAL ADMISSIONS AND MORTALITY – PORTUGAL

admissions

deaths

Source: ONDR 2013

PNEUMONIAE, EVOLUTION OF HOSPITAL ADMISSIONS, PORTUGAL (2010 A 2011)

Source: GDH´s- ACSS/DGS, 2013

Patients discharged Patients discharged excluding ambulatory

Source: INE, IP, 2014

3,6 2,7 2,8 2,6

-5

5

15

25

35

45

2009 2010 2011 2012

213

202,6 205,9

254,1

0

50

100

150

200

250

2009 2010 2011 2012

PNEUMONIAE, STANDARDIZED MORTALITY RATE (/ 100 000)

(under 65 years) (65 or more)

Source: DGS, 2013

HOSPITAL ADMISSIONS COSTS – RESPIRATORY DISEASES

355,1

262,7

232,1

183,8 176,4

0

50

100

150

200

250

300

350

400

D. Aparelhocardiovascular

D. S. Nervoso D. Respiratórias D. MúsculoEsqueléticas

D. Digestivas

Milh

ões €

3ª

Cost per admission

1982 €

Cardiovascular Nervous system Respiratory Musculoskeletal system Digestive system Diseases Diseases Diseases Diseases Diseases

ASTHMA – ICS COSTS

Source: SIM@SNS/SIARS (ACSS), 2013

General Health Literacy

RECOMENDATIONS

To deal with economical/financial difficulties

Increase the rate of vaccination coverage for influenza vaccination >65 y and other risk groups (free of charge)

Promote the control of risk factors at political level, namely tobacco ban legislation

Increase the accessibility to spirometry and other collaboration between PHC and hospital system

Promote the implementation, control and evaluation of the clinical guidelines on CRD

Implementation of the aging group protection

Improvement of health literacy

Thank You!