A successful chronic care program in Al Ain-United Arab Emirates.
BACKGROUND
The cost effective provision of quality care for chronic diseases is a major challenge for health care systems. We describe a project to improve the care of patients with the highly prevalent disorders of diabetes and hypertension, conducted in one of the major cities of the United Arab Emirates.


METHODS
The project, using the principles of quality assurance cycles, was conducted in 4 stages.The assessment stage consisted of a community survey and an audit of the health care system, with particular emphasis on chronic disease care. The information gleaned from this stage provided feedback to the staff of participating health centers. In the second stage, deficiencies in health care were identified and interventions were developed for improvements, including topics for continuing professional development.In the third stage, these strategies were piloted in a single health centre for one year and the outcomes evaluated. In the still ongoing fourth stage, the project was rolled out to all the health centers in the area, with continuing evaluation. The intervention consisted of changes to establish a structured care model based on the predicted needs of this group of patients utilizing dedicated chronic disease clinics inside the existing primary health care system. These clinics incorporated decision-making tools, including evidence-based guidelines, patient education and ongoing professional education.


RESULTS
The intervention was successfully implemented in all the health centers. The health care quality indicators that showed the greatest improvement were the documentation of patient history (e.g. smoking status and physical activity); improvement in recording physical signs (e.g. body mass index (BMI)); and an improvement in the requesting of appropriate investigations, such as HbA1c and microalbuminurea. There was also improvement in those parameters reflecting outcomes of care, which included HbA1c, blood pressure and lipid profiles. Indicators related to lifestyle changes, such as smoking cessation and BMI, failed to improve.


CONCLUSIONS
Chronic disease care is a joint commitment by health care providers and patients. This combined approach proved successful in most areas of the project, but the area of patient self management requires further improvement.
Baynouna
Latifa M
LM
Ambulatory Health Care Services, SEHA, Al Ain, Abu Dhabi, United Arab Emirates. latifa.mohammad@gmail.com
Shamsan
Amal I
AI
Ali
Tahira A
TA
Al Mukini
Lolowa A
LA
Al Kuwiti
Moza H
MH
Al Ameri
Thuraya A
TA
Nagelkerke
Nico J D
NJ
Abusamak
Ahmad M
AM
Ahmed
Nader M
NM
Al Deen
Sanaa M Zein
SM
Jaber
Tariq M
TM
Elkhalid
Abdulkarim M
AM
Revel
Anthony D
AD
Al Husaini
Alhusini I
AI
Nour
Fouad A
FA
Ahmad
Hayat O
HO
Nazirudeen
Mohammad K
MK
Al Dhahiri
Rowaya
R
Al Abdeen
Yahya O Zain
YO
Omar
Aziza O
AO
D002908:Chronic Disease / Q000517:prevention & control / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D003920:Diabetes Mellitus / Q000628:therapy; D006302:Health Services Research; D006801:Humans; D006973:Hypertension / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D015397:Program Evaluation; D017749:Total Quality Management / Q000592:standards*; D014479:United Arab Emirates