Chronic Disease Management Program Examples, The Kaiser Permanente integrated care model, Barriers to Chronic Disease Management, and Chronic Disease Management Programs Future.

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Chronic Disease Management Programs

Chronic Disease

Chronic diseases have an effect on all countries, and the augment in their prevalence is to a great extent attributed to varying demographics, improved life expectancy, changing lifestyles, better disease management, and a better understanding of the factors that cause poor health and disease.

Laboratory, clinical and population-based research has revealed that a few risk factors are responsible for the prevalence of most chronic diseases: unhealthy diet and high energy ingestion, lack of physical activity, and use of tobacco. Alcohol intake, environmental pollutants, age, and hereditary factors also play a role. These risk factors are the same in men and women and across all regions in the world.

The associated healthcare, financial and social burden of chronic diseases, which include diabetes mellitus, coronary heart disease, asthma, chronic obstructive airway disease, hypertension, chronic depression, osteoporosis, end stage renal failure and stroke, are progressively on the increase. In the US alone to be specific, some 125 million people now suffer from at least one chronic disease.

Chronic diseases are a tremendous burden to individuals and to countries and the available traditional healthcare methods are not able to meet the requirements for preventing and reducing this burden. It is because of this problem that chronic disease management has emerged as a new approach to caring for patients with chronic diseases.

Chronic disease management in clinical circles can be defined as an elaborate, systematic, multicomponent strategy for delivering healthcare while involving all members of the population or community who suffer from similar infections.

Cardiovascular disease is chronic and is the first cause of death among the elderly in all countries. This observable fact was evident even 60 years ago, as Roberts noted that diseases of the circulatory system and pneumonia were the first causes of death among the aged in Jamaica in 1950.

These diseases are to some extent the sequelae of advancing age. As life expectancies are increasing the prevalence of all non-communicable diseases is also increasing. Thus, one could adopt the approach that these are foreseeable consequences of aging and the focus, therefore, has to be on simply treating them when they do occur and applying the acknowledged interventions for secondary prevention once the first disease episode has occurred.

It is possible to reduce mortality from chronic diseases in general. Some of the developed countries such as Canada, Australia and the United States have succeeded in reducing mortality by applying preventive measures. Meeting the multifaceted needs of patients with chronic diseases is the single supreme challenge facing our healthcare system in most countries today.

With the increasing numbers of patients suffering from chronic diseases, it is of the essence that clinicians, healthcare administrators and health policy makers plan and ensure that the healthcare delivery system is tailored to provide care for these patients across the band of their healthcare needs. Chronic disease management has been known to be the best and most comprehensive approach for providing holistic and comprehensive care for patients with chronic illnesses.

Kaiser Permanente integrated care model

The Kaiser Permanente care triangle has frequently been used to conceptualize Chronic disease care at three main levels

• Supporting self-care for patients suffering from chronic disease who are at low risk of complications and hospitalization.

• Disease management for people who are in need of regular routine follow-up and are at high risk of chronic disease.

• Case management for people who have complex needs and those who are high-intensity users of unplanned less important care.

Managing chronic diseases at the system level has been the focus of many latest publications.1-4 In the US, the recent Institute of Medicine Report – Crossing the Quality Chasm – focused on the need to reorganize care delivery to meet the healthcare demands of populations of patients who suffer from chronic illnesses.

In October 2001, the British Medical Journal and the Western Journal of Medicine both published special issues focusing on the problem of chronic diseases and tinted how various nations are dealing with this ever-rising epidemic. It is therefore timely that all nations focus on coming up with a better program to address the needs of patients with chronic disease, on the advances in clinical and non-pharmacological management, and the challenges faced in ensuring that patients receive optimal care meeting the needs at the various stages of their disease.

Chronic Disease Management Programs Examples

A successful chronic disease management program should be designed while considering fundamental factors that are critical to its sustainability. First of all the program should be aimed at a certain specific condition within the population suffering. Then the next important factor concerns the availability of evidence on which its functions should be based.

A good program has to keep into its consideration the existence of obstacles that may be a hindrance to its successful implementation. Adequate measures should be put in check to ensure that there is a balance between quality and the economy of the objectives of the care to be given.

United States

In the United States chronic disease management programs, also known as chronic care management, have become extensive. They are being favored by employer groups, healthcare organizations and health payers, these programs are being increasingly raising concern because very little scientific evidence is available to justify their effectiveness and economic impact.

Disease management was introduced and launched in 1990 by drug companies for the purpose of helping patients to comply with various medications and also to increase their sales. This programs have developed in the private sector to become such a competitive industry that these companies contract health plans to offer comprehensive care to various groups. They are then paid a fee by the health plans to guarantee a saving.

Disease management programs are wide in the private sector; they offer care and support as part of benefits and support from physicians. Some programs have been organized in such a way that the physician can receive alerts whenever the patient needs medical attention or even when the services for preventing chronic diseases are long overdue.

Some use professional clinical information systems which can integrate participant’s data for instance data that concerns claim data or self-reports. This can be even acquired from multiple sources. However, there is only a small number of beneficiaries who suffer from chronic illness and therefore account for the disproportionate share of medical expenditure.

This results in such patients receiving fragmented care from a number of site providers and to add to the insult they receive repeated and costly hospitalization. The manifestation project was endorsed by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA).

In adding together to the BIPA projects, there are numerous other “coordinated care” demonstrations approved by Congress in the Balanced Budget Act of 1997, a capitatedDM demonstration recently initiated by the Bush administration, and an end-stage renal disease management demonstration.

People are demanding to figure out ways to do disease management in the public sector that act in response to patient-privacy concerns and that admiration the traditional role of the physician. Disease management programs have no effect on the state budget as they pay for administrative services while they are guaranteed by the government a savings offset in form of claims reduction.

It is important to point out that even though the opportunities for cost savings and step up in health outcomes are great, the challenges of introducing disease management on a wide scale in the Medicare program are momentous. The patients increasing population is likely to bring up challenges that are not found in the private sector.

France

In France, studies have shown a tremendous improvement in the state of health and quality of life for chronic illness patients. There has also been a significant reduction in costs due to the implementation of coordinated networks for the treatment of asthma.

The reduction in costs cannot be attributed to spontaneous national changes in management but rather it can be explained by the effect of the intervention program. This initiative can be said to be the first attempt towards the implementation of a disease management program in France.

Italy

In Italy, the health system is aiming at utilizing Information technology tools to manage chronic diseases. In this country, the population f over 65 years has been noted to be on the rise. What is worrying is that the number of chronic diseases also increases with this range of age.

Approximately 90% of the aged people are suffering from chronic diseases and something has to be done in effect to prevent further repercussions. In the past Italian doctors have raised concern over the time that is used in treating patients with chronic diseases and therefore came up with a resolution to use community care.

With such a program there is a shift from hospital-based care to community-based care. Such a program aims at reducing the number of patients admitted with chronic diseases, removing patients out of hospital quicker, and improving the network for helping people with chronic diseases.

This is to be done while the records are kept centrally and monitored while the services are moved to the community. In Italy, there is also another program being put in place and it is called the sole project as it is aiming at networking all hospitals with communities to give the citizens services. The program is also aimed at controlling the flow of information so as to help elderly patients. The idea must have been copied from the UK’s pathways to telecare.

Germany

In Germany, two laws were passed in the year 2001 to address the main problems in the healthcare system. Despite advances that have been made in the diagnosis and treatment of diabetes, patients still experience secondary complications. The purpose of the disease management program in Germany is to avoid the repetition of diagnostic testing, by specialists or in hospitals thus assisting in containing the cost.

In Germany, chronic disease management programs have a legal basis under which they operate. For instance, in the year 2002, there was a reform law that laid down a complicated procedure for the establishment and implementation of disease management programs. These procedures included the characteristic features of a disease which qualifies to be included in the management programs.

Implementation of disease management programs in Germany has been influenced by politics which is not like in the other countries. Germany has a long experience with disease management programs than the United States.

The healthcare system in Germany has characteristics that have seen the introduction of disease management programs. This includes the free choice of the non-profit sickness funds that have to strike a balance between spending and income. There are also issues regarding efficiency and quality on the side of those who are chronically sick

The ministry of health in Germany anticipated that disease management programs will help to reorganize the fragmented care for people suffering from chronic illnesses. The main challenge towards implementation of the programs regards the definition of the minimum standards proves to be contentious and time-consuming as people continue to suffer.

Another challenge has been in implementing the program for Diabetes whose care requirements has been attacked by more than ten scientific societies. These scientists argue that the government and the sickness funds favored a minimal program that was created based on studies with the highest level of evidence. Some claim that the programs were created under extreme time pressure. (R. Busse 2001)

By way of the “German-style” DM programs, the government anticipated a radicalGordian explanation to a knot of disheveled problems. While the authentic experience with DM programs is by a long way larger and longer in the United States than in Germany, the German strategy could be of interest in the United States, where we have cream-skimming and adverse selection having in fact blocked managed care infiltration into the Medicare population.

One observable difference is the” ownership” of the DM programs; in the United States, they are to some extent connected with pharmaceutical companies or special DMP vendors. When disease management came up in Germany, analogous companies appeared on the market, with the hope of commercial triumph. Some sickness funds contracted them to assist them in preparing DM programs, but such companies have more or less disappeared from the market

The UK

According to statistics in the UK, a lack of proper care to manage chronic diseases on a day-to-day basis can lead to unnecessary complications and premature death. Children also suffer from chronic diseases for instance children below five years account for 15% of the cases (General household survey 2002). Self-care has sometimes been ignored in the UK but it is a well-proven approach to improving the situation of chronic diseases.

According to data from the Department of Health’s Economic and Operational Research the effects of self-care include;

• Reduced visits to GP by over 40% for the high-risk cases.

• Reduction in admissions to hospitals by about 50% in a Parkinson’s diseases

• The length of stay in hospitals for mental health problems reduce.

• Off-work days can reduce by even more than 50% for patients suffering from arthritis

Self-care or management is not just an issue of providing information to the patients but it involves a range of other things to make it workable. Patients need care education regarding self-management of their sickness by helping stand what they ought to do and how to make adjustments towards their medical dosage and how and when they need healthcare. They also need quick reminders of when they should be attending to certain measures concerning their health.

They need support from knowledgeable patients or even an expert in their disease and broader networks which can include attending to group practices involving the same kind of health condition. Their uncertainty regarding self-care however is likely to improve in relevance because of the following:

• The increase of information that is availed to the patients.

• The ability of information technology to support self-care.

• The possibility of having reliable and accurate home monitoring systems.

• The greater anticipation by many patients to be the locus of control.

In the UK the main providers of care for chronic diseases are the primary care teams. They include community nurses, pharmacists, dieticians, opticians, podiatrists, and physiotherapists.

Barriers to Chronic Disease Management

One major factor which hinders the implementation of these programs is the lack of proven after investment. This has tended to limit the health plan and interest of the disease management organization.

Chronic Disease Management Programs Future

There is no acceptable best way for chronic disease management. Evidence that has been observed throughout the world brings out clearly that, to be successful, policy-makers should put into consideration:

• Providing well-built leadership and vision at the national, regional, or organizational level should oversee all that is required for the programs to succeed.
• They should ensure full-bodied collection of information and data-sharing among all the stakeholders in the health sector.
• Care should be provided based on people’s needs and an ability to identify people with different levels of need;
• They should also put in place measures that target key risk factors, including widespread disease prevention initiatives.
• Growing towards supporting self-management and empowerment of people with chronic diseases
• Policy brief should involve a wide range of stakeholders such as individuals, the voluntary and community sector, clinicians, private industry, and public services.

Future Disease management programs should be tailored to reduce the costs associated with care for people suffering from chronic illnesses. The growing costs of operations such as dialysis are still a major concern in most countries. But with the Disease management programs in place, these costs are expected to decline and lead to improved care even through public health for chronic disease cases. However, reducing the costs with DM programs has been successful in some areas but drug treatment especially in diabetic cases seems to be an area where the growing costs are inevitable.

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