There is not question that chronic diseases account for a substantial amount of costs in a health care system. As more and more people are being inflicted with chronic illnesses such as heart disease and obesity, more attention needs to be placed on ways to prevent onset of diseases and to keeping costs low. Preventive care certainly would be an effective way to keep costs low through better health education, early detection, and better management of chronic illnesses. But I think we can do much more.

Our system oftentimes seems too aggregated for the proper treatment of serious chronic illnesses. As Craig mentioned earlier, Germany has Disease Management Programs that are specifically designed to treat specific chronic illnesses. I think implementing such a system would be beneficial to our current system. This would improve continuity of care and ensure a more effective method for treatment of various chronic illnesses.

gov't has a role

Besides preventative medicine, the government can have a role in reducing the incidence of chronic diseases. This issue was discussed in class earlier this semester, as suggested by Geetha. If a majority of chronic disease such as obesity and hypertension are caused by unhealthy eating habits, lack of exercise, and inaccessibility to healthy foods, then the government needs to take a stance on food regulation, reinforce physical education classes in school, and monitor nutritional data. 

The notion of chronic diseases usually does not worry people until they are a victim of a chronic disease. Avoidance of chronic diseases entails life-long management of health which should begin at birth. Adolescents and adults may not see themselves as targets for chronic disease because of the "invisibility" of begin young. Chronic disease may also be an isolated concept within medical and mph student, but for the general public, it usually isn't a daily concern. Mass communications can take a role in educating the public about the gravity of chronic diseases in America. Just like the anti-tobacco campaigns, chronic diseases deserves to be highlighted as well.

Chronic diseases........

The global prevalence of all the leading chronic diseases is increasing, with the majority occuring in developing countries and projected to increase substantially over the next 2 decades . Cardiovascular disease is already the leading cause of mortality in developing countries. Risks for chronic disease are also escalating. Smoking prevalence and obesity levels among adolescents in developing countries have risen over the past decade and portend rapid increases in chronic diseases. Strong beliefs persist that chronic diseases afflict only the affluent and the elderly, that they arise solely from freely acquired risks, and that their control is ineffective and too expensive and should wait until infectious diseases are addressed. Hence a change in stakeholders approach is required. People who take decisions about handling chronic diseases need to be provided with adequate evidence that this is a key area where funds need to be directed.

Compliance remains an important issue when tackling chronic disease. It is not easy to obtain good compliance. It is one thing instructing somebody to do things differently and another actually following the advise. There need to be ways to tackle compliance at a personal and professional level.

Follow up of patients with chronic disease is a herculean task. Our health care systems are not designed in such a way to maintain strict follow up of patients with chronic disease and this is another area where efforts directed could bring in dramatic changes in disease prevalence.

Patients suffering from chronic diseases require long term prescription drugs , sometimes lifelong. These medications need to be more affordable.

At last chronic diseases require more than just a physician, physiotherapists, occupational therapists, psychiatrists have a key role to play. A multidisciplinary approach is required on a dedicated basis to treat these patients.

Needless to say prevention tops the list, if a family has a known history of a chronic disease, individuals in that family should be given the education to equip themselves to avoid risk factors that could prevent them from developing the disease.

Prevention

Prevention is going to be the key ingredient in reducing our health care expenditures and the rates of chronic diseases.  If people begin taking control over their own health and well-being, they will obviously have a better quality of life and those dollars we are currently spending on their care can be put elsewhere.  The problem with all of this is the view of preventive care from the American society.  Many people simply don't understand what preventive care is; they don't realize that it is  lifestyle and not just random doctors visits or lab draws.  Unfortunately, many people do not want to or cannot afford to make this major change and that is where the problem is deeply rooted.  

Overall, I think chronic diseases are the single most burdensome aspect of health care costs and treatment in the United States.  Reducing the prevalence of chronic diseases could single-handedly drop health care expenditures by an incredible amount.  Like I mentioned before, prevention is going to be the answer to this problem.  The only question that remains is how long it will take for prevention to become a lifestyle and not just a theory.

Innovations to overcome chronic diseases

The problems associated with chronic disease and related outcomes might act as the tipping point in terms of being the catalyst for health care reform.  Quite simply, we cannot afford to continue treating chronic conditions in the population.  

There are a few new unique approaches going on elsewhere in the world in regards to chronic disease management and care.  Germany, without giving away too much information in regards to our presentation tomorrow, radically altered their health care delivery in response to the increasing costs associated with chronic disease.  Their research determined that 20% of the population were responsible for 80% of costs.  In response, they created Disease Management Programs, of which we will elaborate on tomorrow.

The Germany example illustrates one of many innovative approaches to treating those with chronic diseases. Researching chronic diseases will be a fundamental part health care in the coming decade (or sooner), their costs and burden on the system are still far from understood and vastly undervalued. 

Chronic disease is multi-faceted

Chronic diseases ARE multi-faceted, so the approach to treating them must be as well. Prevention is a huge part of this, and with that comes health education, promotion of healthier behaviors, policy change to reflect priority shifts, and research and development to know what course is best to take.

We've talked a lot about potential wide-spread health care reform in this country, and how all these little fixes don't actually amount to much change. The real problem as I see it is that each problem is treated as an individual problem, instead of being looked at in the context of a bigger issue. Health IT could be looked at in terms of chronic disease treatment. Health education could be looked at in terms of chronic disease treatment. Policy change could be looked at in terms of chronic disease treatment.... and on and on, you get my drift. Put all of these things together and you have one giant problem that is pleading with us to be fixed.

A huge problem is funding. Always funding. What if there was a shift in thinking to where it didn't matter how much we had to spend on health care to get the best case scenario - not we as in individuals, but we as in the government. After all, the proposed increase in SCHIP funding that President Bush so willingly vetoed TWICE was equal to just 16 days in Iraq -- and I can guarantee that not everybody is on the same page about those dollars. Just think, if we had unlimited dollars to spend on health care, we could do all the research we wanted, for the sake of discovering new things in science. We could provide everyone with the same, high quality of care. We could pay our physicians, yes even the primary care physicians, enough to where they wouldn't base their career choices on what specialty will pay off their medical school debt the fastest. We could educate the public to our heart's content about what is best for them, and how they can take responsibility for their health and their bodies, and not have to worry about cost. We could implement an interoperable, nationwide health IT system, with subsidies to get smaller practices and Medicare/Medicaid providers up and running. Scrap that, we could have universal coverage. The what-if's abound if we think about what we could do to better the health of our nation with unlimited funding and no ceiling on ideals. I truly believe chronic disease rates would go down with equity of care, prevention, treatment, education, dissemination of knowledge, and an overall shift in the way this country views health care.

Hopefully, something will change. Until then, I hope to someday be a doctor who can implement some of those ideals in any way possible.

Improving Chronic Illness Care

The article by Wagner et al, on Improving Chronic Illness Care states, that in order for improvements to happen, there must be changes in our care delivery system. A greater emphasis on prevention would ultimately be the best solution if people actually followed through with preventive behaviors. However, we live in a world where it is difficult to monitor people’s behavior because there are many choices of lifestyles. Also we must remember that nothing is perfect and there will always exist diseases due to biological reasons. In this case, we still need to come up with a plan to improve chronic disease care. The article, states that there has been advancement in the effectiveness of care of major chronic illnesses, but few people actually benefit from these advances. What good is it to have all these great solutions if they are not being effectively disseminated across the country, if not all people have access to long-term health care, if only a few people can afford treatments, and resources are limited? I believe that in order to reduce the prevalence of chronic illnesses, there needs to be a change in the health care system that not only puts a greater emphasis on prevention, but facilitates access to health care, improves long-term care, and provides community level resources to monitor and support healthy behaviors for those with chronic illness.