The title above is related to chronic disease management. For this topic, I would explain how we can improve chronic disease management at different levels in our health system. This topic is important because chronic diseases such as heart disease, diabetes mellitus or stroke have been increasing in low, middle and high income countries. People now are living longer even though they are having disease that cannot be cured. This phenomenon occurs due to the advance in health care and technology. Before we go into details related to chronic disease management, I would like to give some definitions. According to WHO, chronic disease is the diseases of long duration and generally has slow progression. CDC has different version of definition. According to CDC, chronic disease is a disease that cannot be cured once acquired. Other than that, criteria of having the condition for three months or longer are included in this definition. There are many risks of developing chronic diseases such as physical inactivity, unhealthy diet and tobacco use that are modifiable and age and hereditary factors that are non-modifiable.
Management.
Chronic disease management is defined as systematic approach to coordinating health care intervention across the levels (individual, organizational, local and national). Three main levels underpinning by population-wide disease prevention and health promotion are formulated from Kaiser Permanente care triangle. These include the self supporting care, disease management and case management. The management as mentioned above focus on three levels.
The first level is the individual levels. There are many approaches that can be used at this level such as psychological and behavioural theory, stages of change model and some of the case managements. Stage of changes is one of the effective methods used and originated from the intervention of smoking cessation as well as alcohol and drug addiction. There are five levels in this approach including pre-contemplation, contemplation, decision, action and maintenance. These processes can take place in many setting such as in the hospital. Other than that, telephone can also be used as one of the individual proactive support. This is proven by United States. Even though some approaches seem to be simple, but that does not mean that they are easy to be carried out. A lot of considerations such as the affordability of individual, the availability of the technology, the accessibility of population, cultural view and etc should be taken into account. Moreover, we can take one of the examples in stage of changes that involved nurses as care managers, physician and specialist working together. This study was carried out in the one of the region in Italy. This study used team-based model and stage of change. The stage of change was carried out by nurses who supported patient with regular motivation and reminders, acts as signposting service to other resources and coordinate care for individual at general practices. This intervention used face-to-face approaches rather than telephone.
The second level is the delivery-level initiative. The concept of generic chronic care model originated from US is now being adapted to Europe countries. This concept consists of six interdependence components that are important in chronic care management: health care organization, decision support system, self management support, clinical information system design and resources and policies. Some governments have provided incentives for improving the health care management in chronic disease case as well as new risk adjustment mechanism.
The third level is the system wide initiatives. There are many countries implementing service delivery policies even though they aspire to system wide approach. In order to carry out this approach, we need to understand about the scope of this level. Basically, it is similar to the second level but the focus is different. System-wide level focus on the policies, structures and community wide resources needed for the implementation of long term changes. WHO’s innovative care for Chronic Conditions Framework, focuses more on the policies and community aspect. Furthermore, other system wide policy approaches are the ecological or public health model for chronic diseases. Population wide policies, community activities and health services are important as principles.
In conclusion, in order to make the chronic disease management to be effective, we need to learn from the other countries. Even though, Indonesia is one of developing countries, early policies approach can lead to a better management in chronic disease. As I mentioned above, the other considerations such as cultural and accessibility factors, needs to be taken into account when formulating and stipulating the new policy.
The third level is the system wide initiatives. There are many countries implementing service delivery policies even though they aspire to system wide approach. In order to carry out this approach, we need to understand about the scope of this level. Basically, it is similar to the second level but the focus is different. System-wide level focus on the policies, structures and community wide resources needed for the implementation of long term changes. WHO’s innovative care for Chronic Conditions Framework, focuses more on the policies and community aspect. Furthermore, other system wide policy approaches are the ecological or public health model for chronic diseases. Population wide policies, community activities and health services are important as principles.
In conclusion, in order to make the chronic disease management to be effective, we need to learn from the other countries. Even though, Indonesia is one of developing countries, early policies approach can lead to a better management in chronic disease. As I mentioned above, the other considerations such as cultural and accessibility factors, needs to be taken into account when formulating and stipulating the new policy.
Reference:
1. Singh, D. How can chronic disease management programmes operate across care settings and providers. WHO Regional Office for Europe and European Observatory on Health System and Policies. 2008.
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