Golden Opportunities

A chronic disease can dramatically alter the way you live. But new developments in care management can help you rebalance your life. Here to explain is Dr. Nicholas Dreher, Associate Medical Director of Primary Care Services for Kaiser Permanente.

Question: What's the difference between having a frequent illness and a chronic disease?

Answer: A frequent illness has a cure, even if it may recur. A chronic disease is one that does not go away and requires treatment rather than a cure. It has the potential to shorten your life and requires you to make adjustments to your lifestyle in order to manipulate and fight the disease.
Although there are many chronic diseases, the most common include diabetes, hypertension, heart failure, and arthritis.

Question: How can we successfully cope with a chronic disease?

Answer: To successfully cope with a chronic disease, the patient has to engage it. How? First, they need to educate themselves and understand the disease. They will need to take medication. And they must schedule more frequent visits with their doctor, to monitor care.

Question: That's what's always available no. Can you offer more hope on new ways to cope with chronic disease?

Answer: As in all medicine, the push is for the physician and patient to work together to create new treatment options. When it comes to chronic care, more management of these diseases in the future may occur by the patient at home.
Recent studies show that patients able and willing to educate themselves on their disease and monitor it at home lived longer and did better than those who made periodic doctor visits. Of course, the patients in the study had the support and help of researchers, so this approach has not yet been studied in the "real world," but chronic care management is definitely going in this direction.

Question: Can you give us an example of how this might work?

Answer: Yes. A simple example would be a patient who has hypertension. They would be taught how to take their blood pressure and given a blood pressure cuff to use at home.
The doctor would prescribe a medication with three different doses. The patient would be instructed to take the lowest dose for three days, and then take their blood pressure.
If the blood pressure did not reach a certain goal, they would up the medication to the second level of dosage, informing the doctor. They would repeat the process again in three days. Only if that does not work would the doctor and patient have to meet again.
As you can imagine, the above scenario, with its quick three-day adjustments, gives the patient better treatment more quickly than if the patient simply had a follow-up appointment with the doctor after one month.

Question: What are the challenges with this approach?

Answer: There are several. First, the hypertension example I just gave is relatively straightforward. However, someone with diabetes, for example, would have to monitor his or her blood sugar, blood pressure, and lipids (cholesterol). It can get complicated quickly.
Materials must be gathered to educate the patient on their chronic disease.
The infrastructure of the healthcare system needs to be updated. For example, nurses must be prepared to support patients when they call to report their findings or for assistance, and communication must be more open and quick between patient and physician (Kaiser Permanente does have email now, which helps the communication process).
Although there are challenges, the wave of the future in medicine will include getting care closer to the patient, especially when it comes to chronic disease management.

Care for chronic disease is moving closer and closer to home. For more information on treatment of chronic illnesses, give Kaiser Permanente a call. Mention Golden Opportunities and get a free copy of the Healthwise Handbook. My thanks to Dr. Nick Dreher.