Detroit, Mich. Feb. 24, 2000 -- According to the latest issue of the British Medical Journal, large employers and government payers of medical services looked to health maintenance organizations during the 1980's to control escalating health care costs. But by the 1990s, the "quick fixes" had run their course, and management of chronic conditions became the centerpiece for quality and cost control. In the United States, typical of industrialized countries, the four top chronic diseases (cardiovascular disease, cancer, chronic obstructive pulmonary disease and diabetes) together are responsible for 72 percent of deaths each year.
The British Medical Journal and its sister publication, the Western Journal of Medicine (covering the Pacific states of the U.S.) have both focused current special issues on the management of chronic disease. This week's special issue of BMJ addresses the unique demands that chronic illness makes on patients, families, and healthcare systems, and the effectiveness of interventions to meet these demands. Failure to meet these demands, most of them low-technology in nature, helps to explain why advances in the development of specific treatments have far outpaced reductions in morbidity and mortality. For example, despite dramatic improvements in clinical treatments for asthma, death and disability associated with the disease are at an all time high.
"Just as chronic disease control has developed into a distinct discipline in public health, so chronic disease management is now beginning to develop its own identity as an important component of health care," said BMJ's North American Editor, Ronald Davis, M.D.
Edward Wagner, M.D., Director of the W.A. MacColl Institute for Healthcare Innovation at the Center for Health Studies, Group Health Cooperative of Puget Sound, author and co-author of two articles and the special issue's lead editorial, emphasizes that each chronic illness should not be considered in isolation, but that similar strategies might be equally effective in treating many different chronic conditions. "Perhaps most important is the need to change systems of practice to meet the needs of chronically ill patients, especially interventions that help patients to change their own risky behaviors and to become better managers of their own health conditions," he said. Other researchers featured in the issue state that the patient should be the primary manager of chronic disease, guided and coached by a doctor or other practitioner to devise the best therapeutic regimen.
British and U.S. authors in this issue compare the emergence and current role of for-profit companies that sell programs to manage chronic disease. Although promised cost savings are typically the selling point for these services, it is important to know whether they also improve outcome and patient satisfaction. British researchers, skeptical of how for-profit entities fit into their national healthcare system, offer a checklist of quality standards to use in negotiating with disease management companies.
Other papers contributed to this issue of BMJ conclude that:
- Most systematic reviews of asthma treatments -- many of which were supported by companies with commercial interests -- have serious methodological flaws.
- Attempts at reassuring patients newly diagnosed with chronic conditions often provoke anxiety -- not because physicians do not spend sufficient time with their patients, but because they need to communicate differently.
- Compared to pre-determined appointment schedules, flexible follow-up treatment of inflammatory bowel disease does not increase costs but does increase patient and provider satisfaction.
- Adding telephone follow-up to the treatment of patients newly diagnosed with depression increased average costs by $80 per patient, but improved depression by more than 50 percent compared to patients with no telephone follow-up.
- For patients to become effective members of their own care management teams, they must acquire important behavioral skills, not just knowledge.
For further information about the British Medical Journal or to obtain a full-text version of the study, please contact Jill Shepherd on +44(0)171 383 6529, Public Affairs Division, British Medical Association, BMA House, Tavistock Square, London WC1H 9JP or email: jshepherd@BMJ.com or pressoffice@bma.org.uk. After 6 p.m. and on weekends telephone: +44(0)181 241 6386/+44(0)181 997 3653/+44(0)181 674 6294/+44(0)1525 379792/+44(0)181 651 5130.
Posted by the Center for the Advancement of Health <www.cfah.org>. For information about the Center, call Petrina Chong, <pchong@cfah.org> (202) 387-2829.