Mousetes, Steven

Wallace, Lorraine S.

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Medical and Healthcare Innovation in Estonia1https://slaviccenter.osu.edu/Lorraine S. Wallace, PhD, Associate ProfessorCollege of Medicine Department of Biomedical Education and AnatomyLorraine.Wallace@osumc.edu Steven Mousetes, MEd, MLS, Program ManagerCollege of MedicineDepartment of Biomedical Education and AnatomySteven.Mousetes@osumc.edu 2https://medicine.osu.edu/Section 1: Estonia OverviewSection 2: Estonian Population Health DemographicsSection 3: Estonian Healthcare SystemSection 4: Estonian Personalized MedicineSection 5: Additional Estonian Health-Related Resources Module Content34Estonia OverviewSection 1Population:  1.3 millionCapital:  TallinnOfficial Language:  EstonianOfficial Currency:  euroGeographical Location and Demographics5https://estonia.ee/Estonian Soviet Socialist Republic, 1940-19906Estonian Flag7President Kersti Kaljulaid Prime Minister Jüri RatasRepublic of Estonia Government8https://president.ee/en/president/biography/index.html https://www.valitsus.ee/en/government-members/prime-minister-juri-ratasEstonian Ambassador Jonatan VseviovEstonian Embassy in the United States9https://washington.mfa.ee/US Ambassador Brian RoraffUnited States Embassy in Estonia10https://ee.usembassy.gov/Ohio State University students visit the University of Tartu in Estonia11https://educationabroad.osu.edu/index.cfm?FuseAction=Programs.ViewProgramAngular&id=1069912Estonian Population Health DemographicsSection 2Estonian Population by Sex and Age, 1992 and 201713https://spkc.gov.lv/upload/jauns/health_in_the_baltic_countries_2016.pdfEstonian Life Expectancy, 1960-201514https://data.worldbank.org/indicator/SP.DYN.LE00.MA.IN?locations=EELife Expectancy, at Birth, of Select Countries, 201815https://data.worldbank.org/indicator/SP.DYN.LE00.INCountry Life Expectancy at Birth (years)France 80Finland 79United States 76Estonia 74Lithuania 71Latvia 70Leading Causes of Death in Estonia, 201716Ranking Disease/Condition1 Ischemic heart disease2 Hypertensive heart disease3 Stroke4 Alzheimer's disease5 Lung cancer6 Colorectal cancer7 Cirrhosis8 Stomach cancer9 Chronic kidney disease10 Pancreatic cancerhttp://www.healthdata.org/estoniaLeading Causes of Disability in Estonia, 201717Ranking Disease/Condition1 Low back pain2 Falls3 Headache disorders4 Diabetes5 Depressive disorders6 Age-related hearing loss7 Stroke8 Neonatal disorders9 Alcohol use disorders10 Neck painhttp://www.healthdata.org/estoniaEstonian Human Development Component Indices and Human Development Index, 1990-201818http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/EST.pdfRank Country(ies) HDI Value1 Norway 0.9542 Switzerland 0.9463 Ireland 0.9424 Germany and Hong Kong 0.93910 Netherlands 0.93315 United States and United Kingdom 0.92025 Spain 0.89330 Estonia 0.88234 Lithuania 0.86939 Latvia 0.854Human Development Index (HDI) of Select Countries, 201919http://hdr.undp.org/en/content/2019-human-development-index-ranking20Estonian Healthcare System StructureSection 3Town Hall Pharmacy (Raeapteek, 1422)21https://www.visitestonia.com/en/town-hall-pharmacyMedical Education in Estonia22https://www.ut.ee/en/prospective-students/medicine-studiesHealth Expenditures in Gross Domestic Product (%)—2016 to 2018236.711.610.95.7 6.79.617.7ESTONIA CANADA JAPAN LATVIA LITHUANIA UNITED KINGDOMUNITED STATESEstonian Health Care System Organizational Structure 24https://www.haigekassa.ee/en• Patient Portal• Digital Prescriptions• e-Ambulance• e-Consultation• Interoperability• International ExpectationsOverview of e-Health Services in Estonia25https://www.youtube.com/watch?v=H4QLzQGMI3kYear Milestone1991 National reforms focus on establishing primary care as the foundation of the healthcare system1993 Family medicine was recognized as a medical specialty2001 Health Services Organization Act—Primary care was identified as first point of contact for patients within the health system2003 University of Tartu—Family Medicine residency training program was established2005 Family Doctor Hotline—24 hour access to primary care health consultation, in both Estonian and Russian languages, was now available to nationwideSignificant Primary Care Milestone Timeline 26https://www.euro.who.int/__data/assets/pdf_file/0011/377417/hit-estonia-eng.pdf?ua=1Primary Care• Patients identify a personal family physician through the Estonian registry.• Great majority (≈800) of family physicians are contracted through the Estonian Health Insurance Fund.Access to Healthcare throughout Estonia27https://www.terviseamet.ee/en/healthcare/how-choose-or-change-family-physicianSpecialty Care• With the exception of psychiatry, gynecology, dermatology or ophthalmology, referral from a patient’s family physician is needed for specialty consultation.• Specialty care is available in large cities (Tallinn, Tartu and Parnu).Practicing Healthcare Personnel, 201628326110Physicians Nurses DentistsPer 10 000 Estonian Population https://www.euro.who.int/__data/assets/pdf_file/0011/377417/hit-estonia-eng.pdf?ua=1Determinants of Health29https://www.cdc.gov/nchhstp/socialdeterminants/faq.htmlHealth is influenced by many factors, which may generally be organized into five broad categories known as determinants of health: • Genetics• Behavior • Environmental and physical influences • Medical care• Social factorsSocial Determinants of Health30https://www.who.int/social_determinants/thecommission/en/Goals of the World Health Organization’s Commission on Social Determinants of Health:• Improve daily living conditions• Tackle the inequitable distribution of power, money, and resources• Measure and understand the problem and assess the impact of actionBehavioral Risk Factors in Estonia31https://www.who.int/social_determinants/thecommission/en/Behavioral Risks Percentage of Deaths due to Behavioral RisksPoor diet (e.g., high sodium, high saturated fat) 26%Cigarette smoking 15%Excessive alcohol consumption 10%Low physical activity 3%32Estonian Personalized MedicineSection 4Defining Personalized or Precision Medicine33“Personalized medicine is an emerging practice of medicine that uses an individual's genetic profile to guide decisions made in regard to the prevention, diagnosis, and treatment of disease. Knowledge of a patient's genetic profile can help doctors select the proper medication or therapy and administer it using the proper dose or regimen.”https://www.genome.gov/genetics-glossary/Personalized-MedicineHuman Genes Research Act (HGRA)Established: December 13, 200034HGRA Objectives:• Regulate the establishment and maintenance of a gene bank• Organize the necessary genetic research• Ensure the voluntary nature of gene donation and the confidentiality of the identity of gene donors • Protect persons from misuse of genetic data and from discrimination based on interpretation of the structure of their DNA and the genetic risks arising therefromhttps://www.who.int/genomics/elsi/regulatory_data/region/euro/078/en/Estonian Biobank35• Estonian Biobank is a population-based biobank of the Estonian Genome Center at the University of Tartu (EGCUT).Estonian Biobank Cohort36• Cohort size is currently 200,000 gene donors (≥18 years of age) • Estonians: 83%, Russians: 14%, other nationalities: 3%• All subjects have been recruited randomly by general practitioners and physicians in hospitalshttps://genomics.ut.ee/en/about-us/estonian-genome-centreComputer Assisted Personal Interview (CAPI)37• Personal data (e.g., place of birth, place(s) of living, nationality)• Genealogical data (e.g., family history of medical conditions spanning four generations) • Educational and occupational history • Lifestyle data (e.g., physical activity, dietary habits, smoking, alcohol consumption, women’s health, quality of life)https://genomics.ut.ee/en/about-us/estonian-genome-centre38Additional Estonian Health-Related Resources Section 5Additional Resources39• e-Estonia• Estonia Health System Review• Estonian Chamber of Commerce and Industry• Visit Estonia• What the U.S. Medical System Can Learn From Estonia

Medical and Healthcare Innovation in Estonia

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Medical and Healthcare Innovation in Estonia

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