Health Affairs, 28, no. 1 (2009): 178 doi: 10.1377/hlthaff.28.1.178 © 2009 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Global Insights

PROLOGUE

Global Insights

Yet the complexity of chronic diseases and the need to involve patients closely in their management lead to numerous questions common to many countries. What works best in preventing chronic illness and in delivering care for chronically ill patients? What’s the appropriate size and composition for a chronic care team? The best way to communicate with patients? To integrate care?

Chris Ham of the University of Birmingham (England) discusses the origins, organization, and results of these types of efforts in one of the four arms of the U.K. National Health Service (NHS)—the one serving England. The NHS distinguishes three broad approaches: helping people become "expert patients" for managing their own conditions; using primary care teams for disease management; and identifying patients with complex needs and helping them live more successfully at home and reduce emergency hospital visits. The paper underscores the importance of acting on all of these fronts simultaneously to improve overall care. But it also notes that the overall investment in the NHS’s chronic care policy has been modest compared to other initiatives, such as reducing overall waiting times for care in hospitals.

As countries cope with chronic conditions, more data can be gathered on what works best in care delivery from clinical trials. The paper by Julie Sochalski and colleagues examines studies in the management of heart failure in Australia, the Netherlands, the United Kingdom, and the United States. One key finding: patients enrolled in chronic care management programs using multidisciplinary teams—and active in-person communication with patients, rather than contact over the telephone—saw significant reductions in hospital readmissions.

Once various approaches to chronic care are shown to be effective, it’s important to spend enough on them to realize that potential. That’s especially true in poorer countries, where resources are short and where chronic conditions already affect a billion people. Gerard Anderson of the Johns Hopkins Bloomberg School says that international agencies should do more to help these nations capitalize on low-cost and cost-effective ways to treat chronic illness.

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