Navigating the Health Care System

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

AHRQ Podcast
How to Manage Chronic Diseases  (Transcript)  Podcast Help

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