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Longitudinal Chronic Care Needed to Reduce Burden of Disease

Posted 12/20/2012 Categories: heart health, home health, diabetes, chronic care

Last week an important new study drove home a point that deserves wider attention. It is this: managing chronic disease requires an effort that is sustained 24 hours a day, seven days a week, 365 days a year. And no approach is better equipped to achieve that objective than the new, ever-evolving discipline of healthcare at home.

The study, published in the British journal, The Lancet, took a look at the global burden of disease over the last 10 years. It came as no surprise to me that the single biggest contributor to this burden is chronic disease. As life expectancy climbs in the U.S., so, too, does the number of years people will live with chronic diseases ranging from diabetes and high blood pressure to heart disease and mental health disorders. This shift in longevity calls for the U.S. healthcare delivery system to change its paradigm, and dramatically so.

That overarching shift in strategy can only be accomplished through a model that truly integrates and coordinates care – and that, more specifically, partners primary care physicians, nurse practitioners, therapists and other healthcare professionals with providers of high-quality healthcare at home. Healthcare delivery should no longer consist, for example, of a twice-a-year check for a blood pressure or a four-day hospital visit for pneumonia. That kind of episodic engagement, though highly valuable, ultimately represents short-term thinking.

Rather, healthcare has to be practiced year-round, and even minute-by-minute. Managing patients with chronic disease should involve daily monitoring of the most vital criteria, including blood pressure, diet and physical activity. Only then can our patients meet the daily functional goals of day-to-day living.

Others have made this argument before. Dr. Ed Wagner and colleagues at the MacColl Center pioneered a model of chronic care management that incorporates these principles. Susan Dentzer, editor-in-chief of the policy journal Health Affairs, said this model “delivers superior patient care and health outcomes.” In short, primary care teams everywhere must reorient themselves. They must team up ever-more with the highly skilled clinicians who are increasingly deployed to care for patients at home.

You can read the entire Global Burden of Disease study at The Lancet.

About the Author

Michael Fleming, MD, FAAFP is the Chief Medical Officer for Amedisys, and Past President of the American Academy of Family Physicians and the Louisiana Academy of Family Physicians. Dr. Fleming has served as Speaker of the Congress of Delegates of the AAFP and as Board Chair of the AAFP Board of Directors. He serves as an assistant clinical professor in the Department of Family Medicine at the LSU Health Science Center and in the Department of Family and Community Medicine at Tulane University Medical School.
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Four Drugs Linked to Two-Thirds of Medication-Related Emergency Hospitalizations

Posted 12/1/2011 Categories: heart health, medication management, side effects, coumadin, diabetes, hospitalizations, insulin, warfarin, chronic care

Researchers from the Centers for Disease Control and Prevention just published a report finding that most drug-related emergency hospitalizations result from a few common medications, not those typically thought of as "high-risk" drugs. The four medications or medication classes that were most frequently linked to hospitalizations were:

  • Warfarin (also called Coumadin)
  • Insulin
  • Oral anti-clotting drugs
  • Oral hypoglycemic drugs for diabetics

Patient education and improved medication management are critically important to help prevent emergency hospitalizations. Sixty-five percent of these hospitalizations were the result of unintentional overdoses. It's easy to be confused and make a medication mistake: the average Medicare patient with a chronic condition (like diabetes or heart disease) fills over 20 prescriptions a year. And a patient with five or more chronic conditions (which includes 20% of the Medicare population) fills an average of 49 prescriptions per year.

If you or your loved one aren't sure what to do if you miss a dose of medicine or what side-effects to watch out for, be sure to talk with your home health nurse. They're trained to help you understand your medications and take them safely, and may have resources - like drug guides, medication trackers and pill boxes - to help you manage your medications. Or if you're not receiving home health care, be sure to talk with your doctor.

The study, Emergency Hospitalizations for Adverse Drug Events in Older Americans, was published on November 24 by the New England Journal of Medicine.

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