Chronic care models: good or bad?

The different chronic care models branched off from disease management with the purpose of focusing on the amelioration of chronic patients care. These models have a tremendous emphasis on integrated care where professionals from different areas interact and collaborate together to produce a more efficient system. Not only do these systems focus on the work the health care team delivers, but also on the active participation of the affected patients and their community. It is very important that there is improvement in the relationship, communication and cooperative disease management between the doctors and the patients in order to provide the proper and cost-effective care. The most renowned models out there are Wagner’s Chronic Care Model (CCM), Canada’s expanded chronic care model, the innovative care for chronic conditions framework designed by the WHO, and Kaiser Permanente’s risk stratification model. The first three models are very similar to each other but have a few variations. The CCM looks to strengthen the resources and policies within the community, have an organized and well-structured healthcare system, encourage self-management support, education, empowerment and provide the necessary tools to patients; create an organized and efficient delivery system design to have more successful ways of health provision, have evidence-based guidelines for professionals to use in order to make better and well-informed decisions, and lastly have and organized and accessible information systems such as databases, medical records, follow-up reminders for the staff, etc. The expanded CCM builds on from the original model to put more weight on the importance of community involvement and to take more action on population health promotion by focusing on the community’s life styles, social determinants, resources and sources of inequality among individuals. WHO’s model on the other hand, builds on from Wagner’s model by giving importance to having a positive policy environment, smarter use of available resources, support legislative frameworks, raise awareness and encourage leadership within the communities. The risk stratification model by Kaiser Permanente was designed to group together patients with similar conditions or health status and to categorize them in three different levels. Level 1 is for individual with better health who can manage their own conditions with the health of primary care professionals and their communities. Level 2 is for patients who have the conditions under control, are able to do self-management but need professionals to monitor their health a little more closely, and level 3 if for patients with more serious or complex conditions who most likely need more help from specialists as well as the team from primary care; this category is considered to be case management.

These models are definitely initiatives to better the provision of health, reduce morbidity and mortality dues to chronic conditions and have healthier communities. However, there seems to be a problem with these types of models—they all tend to center their attention on the actual diseases instead of the patients. The programs developed for certain conditions exclusively focus on those conditions, that is, if a program is designed for patients with diabetes, then the only disease that will get treated is diabetes. But what happens if patients also suffer from other conditions? That is the programs seem to fail the patients; a treatment that works for a specific individual may not work for a different one. Certain diseases have various interactions with other diseases, or the treatment provided for a condition may trigger a complication for a second condition.

More so than having a programs designed to treat specific diseases, I believe it is more important to have programs designed to treat patients more efficiently regardless of their disease or symptoms. Make prevention programs be a priority when developing a health organization’s infrastructure or framework and provide patients, families and communities with education so that they are more capable of self-managing their health and cooperating when other need any type of resource to remain healthy. 

MPZ