Case 6 Chronic Care 18-10-2022
Definition chronic care
A lot of different definitions. The most simple and straight forwarded definition is of the
WHO. This definition is based on two elements:
- Long duration; at least three months
- Chronic diseases tend to be progressive over time; disease keeps getting worse. This
process can be slow or fast but is mostly slow.
The goals of care for those with chronic conditions are not to cure but to enhance functional
status, minimize distressing symptoms, prolong life through secondary prevention and
enhance the quality of life
Chronic care refers to the medical care which addresses a pre-existing or long term illness. A
chronic illness is a human health condition or disease that is persistent or otherwise long-
lasting in its effects or a disease that comes with time. So chronic illness needs to be
managed by chronic care.
Classification of chronic disease - based on nature and course of disease
One category does not exclude the other.
1. Life threatening
2. Intermittent; some chronic diseases such as asthma are moving from stable to a
severe period to stable again
3. Progressively debilitating
4. Chronic mental illness
Classification of chronic disease
- Disease onset is slow
- Disease course is lengthy
- Disease outcome; is the disease fatal or is a long life still possible? No cure
- Degree of incapacitation; does it lead to functional and/or cognitive limitations?
, Why should chronic care be improved?
Goals of care for chronic diseases is not to get better/cure but to enhance functional status,
minimize distressing symptoms, prolong life through secondary prevention and enhance the
quality of life. These goals are unlikely to achieve with the traditional acute, episodic model
of care because this model sees the patient as passive recipient of care and where treatment
aims at return to normal.
Current shortcomings
The current health system is focused on acute rather than chronic care; patients are not
adequately taught to care for their own illness.
- Visits are brief
- Little planning takes place to ensure that chronic (and acute) needs are addressed
- Lacking is a division of labor that would allow non-physicians personnel to take
greater responsibility in chronic care management. Too often, chronic care features
an uninformed passive patient interacting with an unprepared practice team
- There is need for new service delivery models that are characterized by collaboration
and cooperation between professions and institutions of care.
- Lack of coordination of care. With chronic diseases there is a need for a lot of
different types of care, however coordination of these different types of care is
lacking -> patient cannot access all care on time
- Lack of knowledge -> communication between patient and physician is lacking, too
little self-management from patient
- It is not known whether evidence about many medications can be generalized to the
types of patients that have been excluded from trials because of their age or health
problems; however these are the common patients in chronic care. A further
complication is that many people with chronic illness will be receiving treatment for
several conditions and will thus be consuming a complex combination of
pharmaceutical preparations whose combined efficacy and scope for interaction have
never been adequately tested.
So the largest shortcoming in the Dutch healthcare is that the current health care is focused
on acute diseases and not on chronic ones. And there should be more focus on collaboration
and multidisciplinary care.
Multimorbidity per se is only one facet of patient complexity, which also reflects
determinants beyond biological factors that impact on health status and influence the
effectiveness of specific treatments, such as socioeconomic, cultural and environmental
factors and patient behavior.
Shifts within chronic care
1. We go from fragmentation in care to coordination of care
2. Reactive to proactive; from curing to preventing and health promotion
3. Provider driving to patient centered
4. Intuitive to evidence based we strive for more standardized care
Definition chronic care
A lot of different definitions. The most simple and straight forwarded definition is of the
WHO. This definition is based on two elements:
- Long duration; at least three months
- Chronic diseases tend to be progressive over time; disease keeps getting worse. This
process can be slow or fast but is mostly slow.
The goals of care for those with chronic conditions are not to cure but to enhance functional
status, minimize distressing symptoms, prolong life through secondary prevention and
enhance the quality of life
Chronic care refers to the medical care which addresses a pre-existing or long term illness. A
chronic illness is a human health condition or disease that is persistent or otherwise long-
lasting in its effects or a disease that comes with time. So chronic illness needs to be
managed by chronic care.
Classification of chronic disease - based on nature and course of disease
One category does not exclude the other.
1. Life threatening
2. Intermittent; some chronic diseases such as asthma are moving from stable to a
severe period to stable again
3. Progressively debilitating
4. Chronic mental illness
Classification of chronic disease
- Disease onset is slow
- Disease course is lengthy
- Disease outcome; is the disease fatal or is a long life still possible? No cure
- Degree of incapacitation; does it lead to functional and/or cognitive limitations?
, Why should chronic care be improved?
Goals of care for chronic diseases is not to get better/cure but to enhance functional status,
minimize distressing symptoms, prolong life through secondary prevention and enhance the
quality of life. These goals are unlikely to achieve with the traditional acute, episodic model
of care because this model sees the patient as passive recipient of care and where treatment
aims at return to normal.
Current shortcomings
The current health system is focused on acute rather than chronic care; patients are not
adequately taught to care for their own illness.
- Visits are brief
- Little planning takes place to ensure that chronic (and acute) needs are addressed
- Lacking is a division of labor that would allow non-physicians personnel to take
greater responsibility in chronic care management. Too often, chronic care features
an uninformed passive patient interacting with an unprepared practice team
- There is need for new service delivery models that are characterized by collaboration
and cooperation between professions and institutions of care.
- Lack of coordination of care. With chronic diseases there is a need for a lot of
different types of care, however coordination of these different types of care is
lacking -> patient cannot access all care on time
- Lack of knowledge -> communication between patient and physician is lacking, too
little self-management from patient
- It is not known whether evidence about many medications can be generalized to the
types of patients that have been excluded from trials because of their age or health
problems; however these are the common patients in chronic care. A further
complication is that many people with chronic illness will be receiving treatment for
several conditions and will thus be consuming a complex combination of
pharmaceutical preparations whose combined efficacy and scope for interaction have
never been adequately tested.
So the largest shortcoming in the Dutch healthcare is that the current health care is focused
on acute diseases and not on chronic ones. And there should be more focus on collaboration
and multidisciplinary care.
Multimorbidity per se is only one facet of patient complexity, which also reflects
determinants beyond biological factors that impact on health status and influence the
effectiveness of specific treatments, such as socioeconomic, cultural and environmental
factors and patient behavior.
Shifts within chronic care
1. We go from fragmentation in care to coordination of care
2. Reactive to proactive; from curing to preventing and health promotion
3. Provider driving to patient centered
4. Intuitive to evidence based we strive for more standardized care
