CDM? CCM?

Chronic Disease Management (CDM)

As I was preparing for my Week 4 tutorial, I came across something intriguing that I would like to share it to those who read my blog on health system. The interesting yet intriguing read was about chronic care management.

What is chronic care management? What is chronic disease management?

Let’s begin by understanding the term chronic disease. Firstly, chronic diseases are prolonged conditions that often do not improve and are rarely cured completely. Diabetes, depression, congestive heart failure, hepatitis and asthma are examples of chronic diseases. Approximately 1 in 4 British Columbians have benn diagnosed with one or more chronic diseases.

Chronic illness has a profound effect on the physical, emotional and mental well-being of individuals suffering from it, often making it difficult to carry on with daily routines and relationships. However, in many cases, deterioration in health can be minimized by good care. This often depends upon individual choices made on a daily basis as well as the collaboration of the physicians in charge as well.

Chronic care management encompasses the oversight and education activities conducted by professionals to help patients with chronic diseases such as diabetes, high blood pressure, lupus, multiple sclerosis and sleep apnea learn to understand their condition and live productively with it. This term is equivalent to disease management (health) for chronic conditions, i.e. Chronic Disease Management. The effort involves motivating patients to persist in necessary therapies and interventions and helping them to achieve an ongoing, reasonable quality of life.

Chronic disease management (CDM) is a systematic approach to improving health care for people with chronic disease. Health care can be delivered more effectively and efficiently if patients with chronic diseases take an active role in their own care and providers are supported with the necessary resources and expertise to better assist their patients in managing their illness.

So, may I ask why CCM/CDM emerges or surfaces into the medical health system? This is because usual care is not doing the job; dozens of surveys and audits have revealed that sizable proportions of chronically ill patients are not receiving effective therapy, have poor disease control, and are unhappy with their care.

Although acute care has characterized all medical care until recently, several varieties of managed care have emerged in the past decades in an effort to improve care, reduce unnecessary service utilization and control spiraling costs. Despite its initial promise, however, managed care has not achieved truly coordinated care. In actual operation it appears to emphasize its fiscal goals. Moreover, managed care does not address the complexity of chronic conditions, and in the interests of cost-cutting, tends to reduce time with patients rather than increase it.

Well, Dr. Wagner has his own opinion on the matter. He believes that if we are to improve care for most patients with chronic illness, the evidence strongly suggests that we reshape our ambulatory care systems for this purpose. Primary care practice was largely designed to provide:

• ready access and care to patients with acute, varied problems,
• with an emphasis on triage and patient flow;
• short appointments;
• diagnosis and treatment of symptoms and signs;
• reliance on laboratory investigations and prescriptions;
• brief, didactic patient education; and
• patient-initiated follow-up.

Patients and families struggling with chronic illness have different needs, and these needs are unlikely to be met by an acute care organization and culture. They require:

• planned, regular interactions with their caregivers,
• with a focus on function and prevention of exacerbations and complications.

This interaction includes:

• systematic assessments,
• attention to treatment guidelines, and behaviourally sophisticated support for the patient's role as self-manager.
• education to the patient on the benefits of treatment and the risks of not properly following their treatment regimen.
• patients need to be motivated to comply because treatment usually produces an improved state, rather than the results that most patients desire -- a cure.

These interactions must be linked through time by clinically relevant information systems and continuing follow-up initiated by the medical practice.

In the next post, I would like to emphasize on the elaboration of a chronic care model developed by Dr. Wagner and his collaborators, its standards and guidelines, importance, structure as well as its components. Tune in to my next post as it will reveal the solution for tackling the problems that occurred in the current acute-care model of care delivery.

References:

Wagner, E.H. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998;1:2-4.

Ware, N.C., et al. (2000). Clinician experiences of managed mental health care: A rereading of the threat. Medical Anthropology Quarterly, 14(1), 2-27.

Wagner EH. Managed care and chronic illness: health services research needs. Health Serv Res. 1997;32:702-14.

http://en.wikipedia.org/wiki/Chronic_care_management

http://www.acponline.org/clinical_information/journals_publications/ecp/augsep98/cdm.htm