MANAGED CARE OF CHRONIC CONDITIONS

Chronic Conditions: Discuss what is meant by a chronic condition
Introduction
Chronic illnesses are rapidly becoming the major concern in the healthcare industry globally. Consequently, the World Health Organisation (WHO) has partnered with various organizations in the private sector to adapt and promote improved care of patients with chronic illness throughout the globe (Van Lerberghe, 2008). This initiative extends to the community aspects of better medical care for chronic diseases and involves policies and structures at the patient and family level, community and healthcare institutions level, and the policy level. This paper will define chronic conditions, describe their nature, identify steps which have been taken to improve the medical care of patients, and highlight recommendations for future improvements.
Definition and Nature of Chronic Conditions
Bodenheimer, Wagner, & Grumbach, (2002, p. 7) defines a chronic disease as one that lasts for a long time, specifically more than three months. These conditions do not just disappear and cannot be treated by medication or prevented by the use of vaccines. More than 85 percent of Americans over the age of 65 years have been diagnosed with at least one chronic disease. These chronic conditions are primarily caused by bad lifestyle behaviors such as the use of tobacco, physical inactivity, poor diets, and in some cases the use or abuse of alcohol (Bodenheimer, Wagner, & Grumbach, 2002). Chronic conditions are more prevalent with old age; all the major chronic diseases in most countries around the world (which includes cardiovascular complications such as stroke and heart attack, arthritis, cancer primarily colon and breast cancer, obesity, diabetes, and epilepsy) have all been found to plague the senior citizens.
Although the terms chronic illness and chronic disease are assumed to have a similar meaning in clinical literature, they have distinct meanings (Mira et al., 2016). According to Bodenheimer, Wagner, & Grumbach, (2002, p. 24), chronic disease is the basis of classification of the medical illness; it includes asthma, diabetes, and depression while chronic illness is the individual encounter and experience of having the pain that usually accompanies the disease. However, the two are dependent on each other and continue to be throughout their lifespan. They are significantly affected by external factors such as financial status, education, social status, environment, and employment. In conclusion, Mira et al., (2016, p. 16) says that the disadvantaged in the society will have varied discrepancies in the outcomes of the chronic diseases as compared to the well-up; this is unless the latent determining factors of health and wellbeing of the community are addressed creating health awareness and empowering the community to adopt better lifestyle behaviors.
Obstacles to Ensuring Quality Care
Care of individuals suffering from chronic illnesses is a serious challenge facing the healthcare system globally. This scenario is complicated by the fact that majority of these patients are aged 65 years and above; a majority of this particular demographic group have decreased immunity levels thus making healthcare more complicated and increasing their mortality rate. According to Roberge et al. (2016, p. 9), chronic conditions are the main causes of an unhealthy society and high mortality rates in European countries. However, all is not lost because a methodical approach with sufficient assistance from medical specialists can provide quality medical care for patients with severe chronic conditions. According to Mira et al. (2016, p. 13), this approach has been demonstrated and successfully applied for the following conditions: Diabetes Type 2, chronic musculoskeletal conditions, and hypertension. This section of this literature review will address some barriers that hinder the success of chronic care models:

  • Constraints in Human and Financial Resources.
  • Complications and vulnerability in patients poses unique challenges.

The lack of adequate medical staff in healthcare institutions is a major hindrance in the care of chronic patients as they require lots of personalized healthcare. The management of chronic conditions is enormously resource-intensive and very laborious; this is especially true in high-level healthcare institutions where they mainly focus on treating chronic patients with other co-existing medical conditions (comorbidity) who are likely to have mental disorders and financial and social challenges (Mira et al., 2016). To advance medical care to large groups of patients, staff capacity is a crucial aspect. Healthcare providers have the drive and passion to enlarge and grow such programs, but they are quite aware of the limitations involved in the provision of personalized medical care. In regards to the financial input, the implementation and sustenance of a chronic conditions care program is mostly expensive and is way beyond the financial capability of majority healthcare providers without help from health-based NGOs and other organizations and government programs (Mira et al., 2016).
Two factors among patients complicate efforts towards chronic care: Co-existing conditions and Socio-economic limitations. Immigration status, homelessness, lack of finances, lingual barriers, and drug use or abuse are among some factors which makes it difficult for some patients to seek or access medical care or commit to treatment and follow up plans (Roberge et al., 2016). Consequently, this high rate of no-shows leads to laxity and lack of enthusiasm and commitment among the healthcare provides; additionally, if the population is not engaged in these programs, the ability to improve chronic care is limited. Co-morbidities complicates diagnosis and treatment of chronic diseases; additionally, such patients require extra attention as they are more susceptible to medical complications and fatalities (Roberge et al., 2016).
Steps to Improve Chronic Care

  • Communication, teamwork, and collaboration among all players involved in the healthcare of chronic conditions is essential in the progress and outcome of the disease (Bodenheimer, Wagner, & Grumbach, 2002). The patient should be centralized in the chronic care programs such as heart failure management programs whose care is person-centered. All players involved should also have access to the patient’s information. As a result, a comprehensive ICT and data exchange system is paramount, and the patient (or a family member) should grant permission for the access to this information. According to Bodenheimer, Wagner, & Grumbach (2002, p. 39), the ease of access to a patient’s health data is a crucial step toward quality care.
  • Healthcare providers have integrated technology in their systems to improve engagements with the patients; they have achieved this by installing highly engaging and individualized communication (Roberge et al., 2016).
  • Healthcare providers should be patient-specific in their goals and approaches. On such method is availing near-site and on-site clinical facilities as a strategy to manage medical costs (Bodenheimer, Wagner, & Grumbach, 2002).
  • Federal initiatives towards better chronic care are also worth a mention: the launching of federal programs that reimburses healthcare providers who deliver quality healthcare to patients with more than two chronic conditions (Mira et al., 2016).
  • Medical staff should focus on short-term changes in the patients with the aim of trying to predict long-term outcomes and respond appropriately; this enables the driving of the personalized care approach efficiently and without unforeseen complications and setbacks (Mira et al., 2016).
  • Treatment trials involving co-existing co-morbidities are crucial in tackling the challenge highlighted in the previous section of this paper. As earlier mentioned, co-existing medical conditions in patients provides complications and difficulties in the treatment and management of chronic diseases (Roberge et al., 2016). Trials targeting this specific area can offer insights into better management approaches, and this can help in reducing mortality rates.

Recommendations for Future Improvements
This section highlights some suggestions for future improvements in chronic care:

  • Team-based care should be a major research topic in the future. Earlier in this text, it was seen that team-based approaches are more effective in chronic care. The best constitution of the chronic care team has however not been sufficiently tried and tested in the healthcare institutions. Studies should focus on the comparison of different compositions of teams to review the clinical outcomes and areas of improvement (Roberge et al., 2016).
  • The insurance system should be refined because it is a crucial factor in the general health of society. The population should be consequently be made aware of their options when enrolling in such insurance packages (Bodenheimer, Wagner, & Grumbach, 2002).It is also important to reach out and create awareness among the marginalized and vulnerable communities.
  • Programs and approaches which are tailored to each patient’s needs need to be introduced and the existing ones improved (Bodenheimer, Wagner, & Grumbach, 2002). This recommendation is specifically beneficial to patients with unique challenges such as co-morbidity and problems in socio-economic situations.
  • Treatment models which are centered on the stratification of risks should be applied in chronic care as it allows medical care to be more systematic and targeted. Tests and trials on this concept should be an area of focus in the future (Roberge et al., 2016).
  • Care and treatment plans can greatly help patients manage chronic diseases. Care plans which are specific to the needs of patients should be developed and tested; this is because of the disproportionality of the rates and severity of chronic diseases in different demographic groups. Modern technological trends should be incorporated in the modes of such care plans; such trends include the use of smartphones, YouTube videos, and medical care apps (Mira et al., 2016).

References