New Hope for
Chronic Disease Management
By Carolyn M.
Clancy, M.D.
January 21, 2009
Reforming our
health care system, including better prevention
and treatment of chronic diseases, will get a
lot of attention from the Obama administration
and the Congress.
This makes a lot
of sense. Chronic diseases are illnesses that
don’t generally go away once you get them, and,
in many cases, can’t be cured. They include
diseases such as heart failure, high blood
pressure, arthritis, diabetes and respiratory
disease, and are among the most costly and
common of all health conditions in the United
States.
Seven of every 10
Americans who die each year, or more than 1.7
million people, die of a chronic disease,
according to
recent government data. Notably, many people
have more than one chronic illness. For example,
less than 10% of adults who have diabetes have
this illness only.
A big portion of
our Nation’s total health care spending goes
toward chronic disease care. Nearly three of
every four dollars spent on medicines for adults
age 18 and older went to treat these conditions
in 2005,
data from my agency, the Agency for
Healthcare Research and Quality (AHRQ), has
shown.
If you or a loved
one has a chronic condition, you know that
managing it can be complicated. Getting a timely
diagnosis and finding good, ongoing medical care
are the first steps. What’s more challenging is
managing your condition with the right
medicines, diet, exercise and other lifestyle
changes.
Why is managing a
chronic condition difficult? Because it involves
repeating many actions regularly when the
benefits are not often obvious. They include:
-
Following a medicine routine, which
may mean taking medicines at inconvenient
times or that may have unpleasant side
effects.
-
Making a major lifestyle change,
such as quitting smoking, reducing alcohol
consumption, or losing weight.
-
Taking action when symptoms indicate a
problem, such as scheduling a
doctor’s visit or lab test.
-
Checking symptoms regularly, even daily.
For example, patients with diabetes should
monitor their blood sugar level every day,
but only 60 percent said they do this daily.
Some experts say
our health care system should develop more
programs that help people with chronic
conditions manage their diseases better. These
"self-management support" programs could give
patients the skills to change their behavior and
get healthier or keep their disease from getting
worse.
Successful
programs combine patient education and coaching
interventions, according to
a
recent report from AHRQ. Coaches are care
managers who are trained to work with specific
patients, like people who want help with
controlling their diabetes or asthma.
A team approach
and talking to patients in person helped
patients better manage their congestive heart
failure,
a new study  has found. Care teams and
in-person conversations lowered the percentage
of patient hospital readmissions by 2% per
month.
Making better use
of technology is another approach that holds
promise for patients with chronic conditions.
Studies my Agency funded have shown that
computer systems can help save money and give
better health results.
One project used
a computer system to monitor patients with
congestive heart failure. The system sent data,
such as weight and blood pressure, from the
patients’ homes to the hospital regularly. If
the system detected major changes in a patient’s
health, it sent a notice to the patient and the
physician. Based on that information and a
followup phone call to the patient, the doctor
could decide if the patient needed to go to the
hospital. Not only did this system help patients
better manage their heart disease, but it also
saved money because patients avoided unneeded
hospital visits and medications.
As a physician, I
know that chronic conditions can be challenging
for patients to manage on their own. But I’m
more optimistic that we are starting to see a
trend toward working together and developing the
tools to manage these diseases.
I’m Dr. Carolyn
Clancy, and that’s my advice on how to navigate
the health care system.
More Information
Centers
for Disease Control and Prevention
Chronic Disease Prevention and Health
Promotion:
Chronic Disease Overview
http://www.cdc.gov/nccdphp/overview.htm
Agency
for Healthcare Research and Quality
The National Hospital Bill: Growth Trends
and 2005 Update on the Most Expensive Conditions
by Payer
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb42.jsp
Agency
for Healthcare Research and Quality
Patient Self-Management Support Programs: An
Evaluation
Contract No. 282-00-0005
http://www.ahrq.gov/qual/ptmgmt/
The
Commonwealth Fund
What Works in Chronic Care Management: The
Case of Heart Failure
http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2009/Jan/What-Works-in-Chronic-Care-Management--The-Case-of-Heart-Failure.aspx
Current as of January 2009
Internet Citation:
New Hope for Chronic Disease Management.
Navigating the Health Care System: Advice
Columns from Dr. Carolyn Clancy, January 21,
2009. Agency for Healthcare Research and
Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc012109.htm
|