Organizing Care for Patients with Chronic Illness

Wagner, Edward H.; Austin, Brian T.; Korff, Michael Von

doi:10.2307/3350391

Cited by 2,408 publications

(1,973 citation statements)

References 93 publications

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“…These disorders have much in common with other chronic medical conditions that have contributing behavioral factors (such as diabetes, asthma, and hypertension) . Therefore, CD treatment may benefit from a disease management approach similar to that recommended for these other chronic conditionsspecialty care when the condition is severe, followed by treatment in primary care when the condition is stabilized (Wagner et al, 1996). A disease management model for Chemical Dependency would involve the primary care provider monitoring substance use at each visit, regardless of the purpose of the visit, and, when needed, referring patients to specialty treatment.…”

Section: Discussionmentioning

confidence: 99%

The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients

Mertens¹,

Flisher²,

Satre³

et al. 2008

Drug and Alcohol Dependence

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Introduction-Health problems are prevalent in chemical dependency (CD) treatment populations, and often precede reductions in substance use among untreated populations. Few studies have examined whether medical problems predict better long-term outcomes in treated individuals, or how primary care utilization and CD/primary care service integration affects long-term outcomes among those with health problems Method-In a sample of 598 CD patients in a private health plan, logistic regression models examined whether Substance Abuse-related Medical Conditions (SAMCs), integrated medical and CD care, and on-going primary care predicted remission of CD problems at 5 years.Results-Those with SAMCs were no more likely than others to be remitted at 5 years except among young adults and those with medical, but not psychiatric SAMCs. Higher levels of medical problem severity at intake and receiving integrated CD and primary care in the index treatment episode predicted remission in the full sample and among those with SAMCs. Among those with SAMCs, individuals with ongoing medical care-two to ten primary care visits-in the 5 years following intake were more likely to be remitted at 5 years than those with fewer visits.Conclusions-This study highlights the potentially important role of medical services in the longterm treatment of CD disorders. CD treatment may benefit from a disease management approach similar to that recommended for other chronic medical problems: specialty care when the condition is severe followed by services in primary care when the condition is stabilized.

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Section: Discussionmentioning

confidence: 99%

The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients

Mertens¹,

Flisher²,

Satre³

et al. 2008

Drug and Alcohol Dependence

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“…The LWWCOPD program (9) is based on the Chronic Care Model (CCM) (23). The CCM identifies the essential elements of a health care system that encourages high-quality chronic disease care.…”

Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

Performance Measures in the Management of Chronic Obstructive Pulmonary Disease in Primary Care – A Retrospective Analysis

Kaufmann

Markun

Hasler

et al. 2015

Praxis

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Leistungsmessgrössen in der Grundversorgung von Patienten mit COPD – eine Analyse Zusammenfassung. Hintergrund: Das Befolgen der Empfehlungen für ein gutes Management der chronisch-obstruktiven Lungenkrankheit (COPD) verbessert wichtige Endpunkte. Leistungsmessgrössen (LM) reflektieren die Qualität der Betreuung, dennoch existieren über die Dokumentation dieser Messgrössen bei COPD für die Grundversorgung kaum Daten. Ziel: Überprüfen der Dokumentation von COPD spezifischen Messgrössen in Grundversorgerpraxen des Kanton Zürich. Methode: Retrospektive Auswertung der Krankengeschichten von Patienten mit ärztlich diagnostizierter COPD, über einen Zeitraum von zwölf Monaten. Die Dokumentation der LM wurde durch Berechnen des Prozentsatzes der dokumentierten Parameter bewertet. Zusätzlich erfolgte ein Vergleich der LM Dokumentation mit einer Praxis, die ein strukturiertes COPD-Programm implementiert hatte. Resultate: Es wurden Daten von 115 Patienten aus 14 Praxen, davon 57% männlich, mit einem Durchschnittsalter von 68 (44–93) Jahren, analysiert. 46% waren aktive Raucher mit 56 (22–150 py) Packyears. Komorbiditäten waren in 73% der Fälle dokumentiert, der Schweregrad mit GOLD-Klassifizierung in 70% (GOLD I 11%, GOLD II 64%, GOLD III 21%, GOLD IV 4%).Gemäss Dokumentation hatten die Patienten durchschnittlich 1,4 Exazerbationen pro Jahr. Die Dokumentation der LM lag zwischen 16% (schriftlicher Aktionsplan im Falle von Exazerbationen) und 95% (Raucherstatus). Eine Dokumentation für eine Rauchstopp-Empfehlung fand sich in 74% der Fälle, für die Grippeimpfung in 49%. Eine adäquate medikamentöse Therapie und Instruktion der Inhalation war für 65 bzw. 57%, für pulmonale Rehabilitation in 27% der Patienten dokumentiert. Angaben zu einer kollaborativen und proaktiven Betreuung fanden sich bei 60 resp. 51%. Die Praxis mit dem laufenden COPD-Programm zeigte eine signifikant bessere Dokumentation (p<0,01) für alle LM ausser für die Grippeimpfung. Schlussfolgerung: In der Schweizer Grundversorgung bestehen Lücken in der Dokumentation hinsichtlich der Empfehlungen für eine nutzbringende COPD-Versorgung. Die Identifikation und Überbrückung dieser Lücken ist zentral für mehr Qualität in der Gesundheitsversorgung.

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“…For example, collaborative goal-setting has been associated with improved outcomes in other chronic health conditions, including diabetes mellitus and hypertension, where treat-to-target approaches have garnered greater support (32,33). The Chronic Care Model suggests that optimal outcomes may be achieved by knowledgeable patients actively engaged in collaborative care with a prepared, proactive medical team (34,35). In support of this model for gout, a proof-of-concept study showed that when health care providers educate and engage gout patients to promote positive self-management behaviors, the overwhelming majority of patients (.90%) achieve the SU goal (36).…”

Section: Discussionmentioning

confidence: 99%

Target Serum Urate: Do Gout Patients Know Their Goal?

Coburn

Bendlin

Sayles

et al. 2016

Arthritis Care & Research

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Objective. To examine gout patients' knowledge of their condition, including the central role of achieving and maintaining the serum urate (SU) goal with the use of urate-lowering therapy (ULT).Methods. This study of 612 gout patients was conducted at a Veterans Affairs medical center. Gout patients were included based on administrative diagnostic codes and receipt of at least 1 allopurinol prescription over a 1-year period. Questionnaires were mailed to patients and linked to medical records data. The questionnaire included goutspecific knowledge questions, the Patient Activation Measure, and self-reported health outcomes. Knowledge was assessed descriptively. Multivariable logistic regression was used to determine predictors of SU goal knowledge. Associations of knowledge with health outcomes were examined in exploratory analyses. Results. The questionnaire had a 62% response rate. Only 14% of patients knew their SU goal, while the majority answered correctly for the other 5 gout-specific knowledge questions. In adjusted analyses, having a rheumatologist as initial prescriber (odds ratio [OR] 3.0 [95% confidence interval (95% CI) 1.4-6.2]) and knowing all of the other 5 gout-specific knowledge questions (OR 2.1 [95% CI 1.3-3.4]) were associated with greater odds of knowing the SU goal. SU goal knowledge was associated with self-reported global health status, but not with self-reported health-related quality of life or gout-specific health status. Conclusion. There is a knowledge deficit regarding the SU treatment goal among gout patients receiving ULT, despite generally high levels of other gout-specific knowledge. SU goal information may be an important and underutilized concept among providers treating gout patients.

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Organizing Care for Patients with Chronic Illness

Cited by 2,408 publications

References 93 publications

The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients

The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients

Performance Measures in the Management of Chronic Obstructive Pulmonary Disease in Primary Care – A Retrospective Analysis

Target Serum Urate: Do Gout Patients Know Their Goal?

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