The primary health care in the emirate of Abu Dhabi: are they aligned with the chronic care model elements?

This review was performed based on secondary data sources that are available in the public domain. The search was limited to English language journals or reports. The specific search terms and strategy are displayed in Table 2. Only recently published reports and data that was no more than three years old (i.e. before 2013) were included in the review.

The data collection was obtained through the consultation of bibliographic databases and meta-resources of information as the World Health Organization, World Bank, Institute of Health Metrics and Evaluation, UAE Ministry of Health and Prevention, HAAD, SEHA, and bibliographic references of the official reports obtained. This stage went from September 2014 to March 2016.

The primary search on Google Scholar and PubMed included the following medical subject headings: “United Arab Emirates”, “Abu Dhabi”, “Health System”, “Primary Health Care” and “Chronic Care Model”. Some references of the articles that we found interesting were also screened and a manual search was conducted in all the health related UAE official websites: Ministry of Health and Prevention, HAAD, SEHA, Dubai Health Authority, Statistics Center of Abu Dhabi.

Relevant data were independently extracted from available reports and reviewed considering the study PICOs (population, intervention, comparisons, and outcomes) [11]. The population under study and the comparisons should be from UAE or same geographic regions and the interventions and outcomes relevant to primary healthcare or chronic diseases settings.

The health workforce is one of the key components of the health system and between 2007 and 2013 the UAE’s health system had an active health workforce density of 25.3 physicians, 31.6 nursing and midwifery personnel, 4.3 dentists and 5.9 pharmacists per 10,000 population [12]. During the period 2005–2012, the physician density increased from 19.3 per 10,000 population, while the nursery and midwifery personnel decreased from 40.9 per 10,000 population, and the dentists and pharmacists remained approximately the same [13]. In 2013, the Emirate of Abu Dhabi presented high ratios of physicians (25.1) and of nurses (52.1) per 10,000 population [14]. Translating these figures into absolute numbers, there were 6864 physicians, 1220 dentists, 14,235 nurses, 5332 allied health professionals and 2396 pharmacists divided by 1626 licensed healthcare facilities (public and private) [15] From the 6864 in the emirate, 68.83% are in Abu Dhabi Capital Center, 26.38% are in the Eastern region and 4.79% are in the Western region [15].

Services is a SEHA Health System Facility which is responsible for manage the facilities in a community-based services across the emirate of Abu Dhabi [16]. SEHA is responsible and operates 12 hospitals, 11 dialysis centers, 62 ambulatory healthcare centers and clinics, and 2 blood banks [17], employing a total of more than 17,500 professional staff across all three geographical regions of the Emirate of Abu Dhabi (Fig. 1) [16].

In 2002, there were 35 public hospitals in the UAE, as well as 14 private hospitals and 128 outpatient clinics. At this time, although several small private hospitals have been set up over the past years [3] there was still a tendency for UAE nationals to seek treatment aboard in the United States and Europe. In Abu Dhabi, there were 41 private and public hospitals (10% of all are SEHA’s), 587 healthcare centers (13% of all are SEHA’s), 335 clinics (1% of all are SEHA’s) and 402 pharmacies (14% of all are SEHA’s) in 2013 [15]. During the same year, the private PHC centers and clinics attended more outpatients (5,034,581) comparing with the public ones by SEHA (2,339,645) [17].

The Joint Commission International (JCI) is considered the gold standard in global health care and is part of a global enterprise of dynamic and non-profit organizations that lead the innovative solutions to help health care organizations improving performances and outcomes. The focus of JCI is to “identify, measure and share best practices in quality and patient safety with the world.” It In 2012, the AHS was recognized by the JCI with ‘Gold Seals’, becoming the first institution of this type with such accreditation, in the world [18]. All of the ambulatory healthcare centers and clinics of the eastern region were part of this accreditation scheme [19]. To achieve this reward, these facilities must fulfill specific standards, specific for its own type, in this case – Ambulatory Care, and must address international patient safety/infection control goals, patient access, and assessments, patient records, and information flows and certain administration procedures [20]. These standards are validated by JCI.

From the 62 ambulatory healthcare centers, only one is an occupational healthcare center, 10 are disease prevention and screening centers (primarily for infectious disease residency visa screening), and 9 dialysis centers and clinics [16]. The AHS is also responsible for the Mobile Health Clinics and the School Health Services, which encompasses 298 school clinics (including higher schools, universities and private schools) [17]. Approximately 80% of all AHS patients visits are PHC consultations [17] with diabetes and cardiovascular disease comprising the majority of the chronic disease case load managed in these centers [21].

The AHS, under SEHA, has 38 clinics. From those, 18 facilities are in the region of Abu Dhabi and 20 facilities are in the Eastern region (Al Ain). The AHS does not provide PHC services in the Western region [22].

In 2013, the PHC under AHS adopted the Patient-Centered Medical Home model and principles. This model has the same core foundation as the CCM, with the main objective to provide structure, proactive, and coordinated care for patients rather than episodic treatments for illnesses [17]. As the name of the model suggests, it has the patient in the center surrounded by the primary care physician, the dietician, the nurse case manager, the counselor, the specialty physician, the laboratory, radiology, pharmacy, and the hospital (Fig. 5).

Globally, the this model is influencing some of the reforms in PHC delivery, it was vital to the primary care reform in USA [23]. There is evidence that this model is improving patient outcomes, moderating health disparities and reducing health resources by reducing the number of hospitals visits. The Patient-centered medical home aims to inspire quality care, engage patients and expand access and delivery options [24]. These aims are aligned with the CCM ones and there is more than one study evaluating the Patient-centered medical home interventions, such as patient registers, care plans, e-mails between the patient and health professional (team), self-management strategies and population profiles [23, 25, 26]. These Patient-centered medical home interventions can be easily linked to the CCM elements: clinical information systems, delivery system design, self-managements, and community. The Patient-centered medical home model was only recently implemented in the Abu Dhabi emirate in 2013 and there are currently no publicly available records or reports on the monitoring or evaluation process.