Management of Chronic Disease by Patients

Abstract

Key Words self-management, disease management, self-regulation, disease management assessment s Abstract Chronic conditions dominate health care in most parts of the world, including the United States. Management of a disease by the patient is central to control of its effects. A wide range of influences in the person's social and physical environments enhance or impede management efforts. Interventions to improve management by patients can produce positive outcomes including better monitoring of a condition, fewer symptoms, enhanced physical and psychosocial functioning, and reduced health care use. Successful programs have been theory based. Self-regulation is a promising framework for the development of interventions. Nonetheless, serious gaps in understanding and improving disease management by patients remain because of an emphasis on clinical settings for program delivery, neglect of the factors beyond patient behavior that enable or deter effective management, limitations of study designs in much work to date, reliance on short-term rather than long-term assessments, and failure to evaluate the independent contribution of various program components. MANAGEMENT OF CHRONIC DISEASE BY PATIENTSControl of chronic disease continues to dominate the agenda of health care systems; this is because primary prevention and cure are not available for many diseases, and because the population worldwide is living longer with accompanying chronic conditions. Just as it is difficult to put what we know about primary prevention fully into practice (e.g., change behavioral patterns related to diet, physical activity levels, smoking, etc.), so too is it difficult to put into practice what is known about secondary prevention, that is, preventing and managing effects of disease. This chapter explores the factors that enable people with chronic disease to keep their conditions under control. Optimum disease management by the patient for purposes of this discussion is defined as the means to achieve the highest degree of functioning and lowest level of symptoms given the severity of a condition.Worldwide the leading causes of death are heart disease, cancer, and stroke, even in countries where infectious diseases rage. A range of other diseases, although intrinsically less likely to lead to premature death, are exceedingly costly in terms 0163 290 CLARK Figure 1Most common causes of death, United States. Rates are age adjusted to 2000 total U.S. population. These data are adapted from (53).of human suffering and economic productivity. Arthritis, diabetes, and asthma are good examples; HIV/AIDS is another. Although an infectious disease, the potential for slowing progression has caused HIV/AIDS to become a chronic condition as well.The overall burden of chronic disease in the United States is substantial. Figure 1 illustrates the numbers of cases of the major chronic conditions seen in the United States (54). Further, a host of other diseases, each striking smaller numbers of individuals (Parkinson's disease and cystic fibrosis a...

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