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What is Chronic Disease Management?

Posted Sep 17 2008 5:35am

We often hear politicians and policy makers espouse their plans to gear the health care system toward chronic disease management, but I think few (including politicians) really know what this means.  I thought I’d offer an example today of what this really looks like in practice in the form of an asthma planned visit.

I saw two patients during the course of the day with asthma.  They’ve both struggled with it off and on since they were children, but today weren’t having any terribly significant problems.  I asked them to come into the office because as the respiratory cold/flu season begins in the northwest everyone’s asthma will be flaring up.  In the acute episodic care model patients only come in when they are sick.  We care for them after the horse is out of the barn, I frequently tell my patients.

While waiting for me to finish up with my earlier patient, my nurse began the planned visit by having them fill out a questionnaire called the Asthma Control Test (ACT) to help objectify and get a better idea of really how well controlled they were.  When they were done with this we reviewed their history, their ACT scores, their medications, their known triggers, the importance of flu vaccine, and what to do when they get sick.  I took a quick listen to their hearts and lungs so I had a better idea of what they sounded like when they thought they were healthy.  In the end I tinkered with both of their medications ever so slightly and sent them on their way.

Hopefully now with this fresh in their minds this inexpensive though somewhat time consuming care provided will help keep them out of the expensive ER or save them an even more costly hospital admission.  When people go to an urgent care clinic or a retail clinic at Wal-Mart or even an Emergency Room this type of care just doesn’t happen.  This is why “no-appointment necessary” medicine should be considered one of the symptoms and not solutions to our health care woes.  There’s another benefit for my patients as well, they’ll be healthier too–that’s always good.

(More from "The Country Doc" at:  http://thecountrydocreport.wordpress.com

 

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