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Friday, 6 January 2012

Chronic Disease Management: An Ounce of Prevention is Worth the Pound of Care.

Guest blog by NONstop GO

This posting is a special guest article from a reader who wanted to share a valuable resource.  If you are interesting in submitting a guest posting, please contact drphealth@gmail.com  

People coping with chronic diseases don’t always feel “sick” or use a lot of health care services.  However, those that rated their health as poor or fair, as outlined in the recent  report from the Health Council of Canada (HCC), have concerns regarding the management of their chronic conditions and the health system overall.  

The survey respondents that rated their health as fair to poor were; older age, lower education, lower income and more likely to live in a rural area.   On the brighter side, these people were likely to; have access to a regular physician,  able to access same or next-day appointments and,  use less emergency room visits in place of seeing their regular physician.  

Respondents were significantly less likely to rate the care that they receive as excellent or very good.  They do not think the system works well. They identified that test results and medical records were frequently not available when attending specialist appointments. They felt their regular doctor’s office did not help in coordinating their care, did not spend enough time with them, and did not explain things in an easily understandable way.

Concerning, (as per the drphealth blog on medical costs in the US )   these respondents would skip medications, tests, appointments, and treatments because of concern over cost.  So the oldest, poorest, least educated sector of our population, dealing with multiple chronic medical conditions, are least able to afford the care they need to manage their illness.  We must advocate for comprehensive health care to include essential treatments to manage chronic medical conditions -  before these same treatments, prescriptions and tests,  are delivered to these same people in hospitals.

The excessive burden to the health care system for care of chronic diseases was demonstrated in a CHSPR report on chronic diseases .   This report amongst others,  has explored the relationship between chronic diseases and multiple co-morbidities, and found that those clients suffering from multiple chronic conditions used much more health services than those clients with less co-morbidities.  The conclusion was that care that focuses on only one condition does not serve the client well.   A case-management system to provide comprehensive, continuous and person-centred care to clients with chronic medical conditions is recommended.    Several case studies demonstrating the utility and success of chronic disease case management by collaborative, team-based care are outlined in a 2009 HCC report, Getting it Right!  Through effective leadership, clear roles and responsibilities, common values and philosophy, easily accessible electronic medical records, and patient-centred programs and supports, including self-management tools, these teams have managed to significantly decrease the health care utilization of these clients – and improve their health. Although these developments have shown success, they have been slow to gain traction in many jurisdictions.

Stepping it Up!, the report issued in December 2010 by the HCC, reiterated the importance of an all-of-government approach to address the underlying determinants of health. In the meantime, we all should advocate for more comprehensive management of chronic diseases in the face of budgetary restraints and shrinking federal funding support.   

I am anxious to see some action on these three Health Council of Canada reports which should inform government policy and anxious to see an engaged government that is interested in improving the health of Canadians. As a public health professional it is part of my job to educate them what it is going to take to accomplish this goal.  That is my New Year’s Resolution.

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