Chronic care refers to

medical care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health pr ...

which addresses pre-existing or long-term illness, as opposed to

acute care Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery.Alberta Health ServicesAcute care.Acc ...

which is concerned with short term or severe illness of brief duration. Chronic medical conditions include

asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, c ...

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level (hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

emphysema Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterised by air-filled spaces ( pneumatoses) in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the a ...

, chronic

bronchitis Bronchitis is inflammation of the bronchi (large and medium-sized airways) in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi ...

, congestive heart disease,

cirrhosis of the liver Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue repai ...

, hypertension and depression. Without effective treatment chronic conditions may lead to

disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, s ...

. The incidence of chronic disease has increased as

mortality rate Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of d ...

s have decreased. It is estimated that by 2030 half of the population of the USA will have one or more chronic conditions. According to the CDC, 6 out of 10 adults in the U.S. are managing at least one chronic disease and 42% of adults have two or more chronic conditions. Conditions, injuries and diseases which were previously fatal can now be treated with chronic care. Chronic care aims to maintain wellness by keeping

symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...

s in

remission Remission often refers to: *Forgiveness Remission may also refer to: Healthcare and science *Remission (medicine), the state of absence of disease activity in patients with a chronic illness, with the possibility of return of disease activity *R ...

while balancing treatment regimes and

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

. Many of the core functions of

primary health care Primary health care, or PHC, refers to "essential health care" that is based on scientifically sound and socially acceptable methods and technology. This makes universal health care accessible to all individuals and families in a community. PHC in ...

are central to chronic care. Chronic care is complex in nature because it may extend over a pro-longed period of time, requires input from a diverse set of

health professionals A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...

, various

medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field an ...

s and possibly monitoring equipment.

Policy making

According to 2008 figures from the Centers for Disease Control and Prevention chronic medical care accounts for more than 75% of health care spending in the US. In response to the increased government expenditure in dealing with chronic care policy makers are searching for effective interventions and strategies. These strategies can broadly be described within four categories. These are

disease prevention Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...

and early detection, new providers, settings and qualifications, disease management programs and integrated care models.

Challenges

One of the major problems from a health care system which is poorly coordinated for people with chronic conditions is the incidence of patients receiving conflicting advice from different providers. Patients will often be given prescriptions for medication that adversely interact with one another. One recent study estimated that more than 20% of older patients in the USA took at least one medication which could negatively impact another condition. This is referred to as therapeutic competition. Effective chronic care requires an information platform to track patients' status and ensure appropriate treatments are given. There is a recognised gap between treatment guidelines and current practice for chronic care. Individualised treatment plans are critical in treating chronic conditions because patients will place varying important on health outcomes. For example, some patients will fore-go complex, inconvenient medication regimes at the expense of quality of life.

Multiple conditions

One of the greatest challenges in this field of health care is dealing with the co-existence of multiple disorders, which is called multi-morbidity. There are few incentives within current

health care systems Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organizat ...

to coordinate care across multiple providers and varying services. A 2001 survey by

Mathematica Policy Research Mathematica, formerly Mathematica Policy Research, is an American research organization and consulting company headquartered in Princeton, New Jersey. The company provides data science, social science, and technological services for social policy ...

found that physicians feel they have inadequate training to deal with multiple chronic conditions. An increase in the number of chronic conditions correlates with an increase in the number of inappropriate hospitalizations. Self-management can be challenging because recommended activities for one condition may be made difficult because of another condition.

Approach

Chronic care is a patient-based approach to provide chronically ill patients with the knowledge and resources to help them better understand their conditions and to help them to adhere with treatment for better outcomes. Chronic care patients may require the services of a variety of care providers, including dietitians, nutritionists, occupational therapists, nurses, behavioral care, pain management, surgery, and pastoral care. Working in collaboration with the patient, the chronic care provider coordinates care these and other specialist providers. Additionally, the patient may require palliative or hospice care, especially at end of life.

References

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