1.0 Abstract
Individuals with chronic conditions who incorporate effective management mechanisms for their conditions are more likely to be free from signs of depression. This is a result of exposure to valuable information, which despite them realizing that change is difficult, they become responsible and undertake necessary adjustments to handle their situation. The significant aspect of these individuals is the connection between their personal behavior and the need to stay healthy with regards to the support and help they get from their families and friends. Chronic care management entails putting into action beliefs among patients and closely monitoring any symptoms and handling them with an aim of overcoming their conditions. The positively living, chronic individuals understand that their condition is not chronic rather long term and fragmentary. Their perceptions are tailored towards the belief that their lives still have a value and purpose. The purpose of this paper is to explore the dynamics of chronic healthcare in the United States healthcare system providing current information about how chronic patients successfully manage their condition through patient –physician relationship.
Chronic Care
2.0 Introduction
Many individuals with chronic conditions in the United States visit health practitioners to get important information about their status. Despite the happening, health care practitioners consider this process a very significant component of treatment, which plays a major role in motivating healthy behaviors. Physicians who have helped patients in overcoming chronic conditions over the years understand the fact that change is a difficult element for individuals who were born with health conditions and have incorporated them into their lifestyles. Furthermore, they acknowledge the fact that treating patients by administering medication and treatment is not enough, and getting family members and friends to take part is very significant. Friends and family members play a crucial role in ensuring that chronic patients implement managing mechanisms for their health status (Thorpe, 2013). Moreover, health practitioners appreciate the importance of patients who incorporate a team approach, which entails involving other physicians and health services in handling their conditions.
According to mental practitioners, chronic conditions can be devastating both mentally and physically, and hold on the fact that medical practitioners have no other obligation other than attending to health behaviors while treating patients with chronic conditions. This also calls for additional counseling skills for handling the patients. One important aspect that physicians need to consider when handling chronic patient is to exercise patience and giving encouragement to help them succeed in their health journey. The research seeks to find out the dynamics of chronic condition patients-physician relationship within the United States healthcare system. This investigation also provides current information on how chronic patients have managed to overcome their health status through patient –physician relationship.
The research question raised for this investigation is, when is the correct time for a chronic patient to start consulting a medical practitioner and get guidance and relevant information. In addition, the research also raises the question of when do medical practitioners get fully equipped with tools and strategies for addressing patients’ conditions.
3.0 Literature Review
As indicated earlier, the purpose of this study was to explore the dynamics of the relationship between medical practitioners and patients with chronic conditions in developing mechanisms to manage their health status. Historically, the 20th century saw the face of chronic illness in the United States totally transformed. Initially, the United States healthcare system was mandated to be responsible for addressing the needs of people with chronic illness and other infectious conditions. As a result, several strategies put forth by the public health saw a significant reduction in the prevalence of infectious diseases. During this time, the United States population majorly composed elderly citizens. Therefore, the likelihood of chronic condition for aging citizens was an alarming increase. Consequently, the need for developing chronic care management among the US population was required.
Chronic care conditions entailing both chronic diseases and impairments have been one of the public concerns in the United States public healthcare for a long time. An increased number of chronic conditions among the populations, which were disabling lives and affecting patients both mentally and physically, steered the need for chronic care. Since those times, there has a been a major concern among the medical practitioners, patients, and emerging healthcare sectors regarding financial care limitations for the chronic patients besides functional challenges of chronic conditions (Thorpe, 2005).
Although technological advancement has played a critical role in improving chronic patients’ lives, little effort has been achieved in the care delivery systems (Lefebvre, & Bornkessel, 2013). The existing healthcare models still concentrate on the severe illnesses and infectious health conditions giving relevance only to address short-term medical needs. As a result, patients with chronic conditions are forced to go through a situation where they are faced with the challenge of meeting the medical expenditure of their conditions alone. At the same time, functional limitations of chronic patients have not received much needed attention. Many patients, therefore, do not access the required knowledge, tools, and equipment for managing their health conditions.
The existing health condition is structured in a manner that rather than enabling a constructive patient and physician relationship, it hinders the link. For instance, medical payment systems do not provide for collaboration among medical practitioners or a stable pattern for the medically challenged patients. There are no motivational factors, such as rewards or recognition for medical practitioners in the US who have ensured chronic conditions patients get well. Statistically, the prevailing cost of treating health chronic conditions is intensely on the rise. For instance, in 2000, approximately 125 million out of 276 million people in the United States, which is 45% of the total population, were reported to have a given type of chronic illness (Rundall, Shortell, Wang, & Casalino, 2002). Therefore, more than seventy-five percent of health budget was directed to these patients. A projection for the year 2020 predicts that approximately 157 million people in America will be having one or more chronic conditions, which will incur 80% of the total health expenditure (Heron, 2013).
There are four major types of chronic conditions, which are being experienced in almost half of the American population, namely asthma, depression, diabetes, and congestive heart failure (Schiller, Lucas, Ward & Peregoy, 2012). Around 15 million Americans are approximated to have asthma, depression, and diabetes, whereas another 5 million suffer from congestive heart failures (Schiller et al., 2012). These conditions have been associated with many deaths besides generating high medical and other costs incurred. There are many queries raised over the quality of care given to these patients concerning their capability to manage their health conditions. According to a recent investigation carried out, there have been indications that less than half the population living with asthma, depression, and diabetes gets effective treatment (Rundall, Shortell, Wang, & Casalino, 2002).
A large portion of the population is living with multiple chronic conditions (Bodenheimer, Chen, & Bennett, 2009). An analysis conducted by Hoffman and Rice indicates that multiple chronic conditions affect more than a quarter of young adults, half of middle-aged adults, and over 69 percent of the elderly.
It is evidently clear that as the number of chronic illness increases within an individual, the costs incurred with the care involved rises (Wu, & Green, 2000). This implies that patients with multiple chronic illnesses will frequently use healthcare facilities services. The effects of chronic illness among the US population is not only felt in terms of medical expenditure but also losses in terms of early deaths, for instance, deaths of employees resulting in a big loss in the economic sectors (Dall et al.,2013).
3.1 Reasons an Increased Need for Chronic Care Cost
There is an increased need for chronic care cost now than previously because the illnesses were being diagnosed in their initial stages. The advancement in technology, diagnosis, and medication procedures has made it possible for individuals to live longer (Thorpe, 2005). This initial detection of the conditions offers individuals an opportunity to adjust their lifestyles concerning treatment that hampers the active progression of the specific conditions. In most cases, chronic conditions are affected by behavior risk factors, which call for an adjustment from a customary medical model that concentrates on pathogens and disease process. Several elements are entailed in the behavioral models, for instance, diet watch, exercise, tobacco use, and alcoholism among many others. Medical practitioners will often get some form of training to gain skills in managing these conditions. The main role of managing chronic condition lies with the patients, who in the first place must adjust their lifestyles. This is a challenging change of perception from the contemporary belief where the patients entirely dependent on the healthcare medication. Patients are required to play an active role in managing the chronic conditions, using all means like technological advancement in communication.
4.0 Methodology
Chronic care study in the United States majorly relied on qualitative and quantitative research. Data was collected from individuals with chronic illness and medical practitioners who have a direct access to the American healthcare system for chronic care. Research questions entailed in this investigation are:
How do individuals live with chronic conditions successfully?
What are components of a fulfilling physician-patient relationship in chronic care?
What are the equipment and approaches that the patients and medical practitioners seeking to enhance chronic care?
4.1 Research Design
Qualitative data was analyzed in order to define different components of the consequent quantitative investigation. At this stage of the investigation, both the individuals with chronic conditions and medical practitioners were interviewed. Chronic illness patients insisted on the issue of patient motivation and indicated that physicians’ main function was to provide information. On the other hand, medical practitioners viewed chronic care as a personal process, which offers them with a chance to enjoy a good working relationship with patients.
Several patients with chronic conditions were interviewed in this investigation. These individuals were often in a close contact with the healthcare system and were conversant with the dangers and effects of the chronic illness. A clear scrutiny was conducted to ensure that the respondents in this investigation would be in the position to talk from the recent point of view of their personal experience.
4.2 Screening Models for Patients
In order to get an effective representation sample and hitting the target, some telephone, and online interviews were conducted with patients. This was done through random digital dialing and online surveys identified through Harris Poll Online representing every state in the US. The result samples entailed patients in the society with multiple chronic conditions. Regarding the physician-patient relationship in the healthcare system, there was an effective experience within the sample for investigation.
Medical practitioners, respondents were also selected based on experience with chronic ill patients. A sizeable number of physicians was selected that balanced with the patients and the required results. Most of the practitioners were interviewed online and through a telephone conversation. In order to get the most effective sample, the American Medical Association file incorporated online interviews through email, which were successful because of the respondents’ willingness to respond.
5.0 Findings
5.1 Successful and Unsuccessful Patients
This investigation entailed as an aspect of understanding how individuals live with some health limitations imposed as a result of a given chronic condition and their perception of their relationship with physicians. Individuals were also asked about how fruitful they were managing their health conditions. Those who indicated they were positively managing their conditions indicated that they had made some adjustments in their lifestyles, for instance, exercising, watching diet, and strictly taking medication according to prescriptions. Unsuccessful patients on the other side indicated they had tried to adjust to the named changes. For all individuals with chronic illness, it is logical for them to realize the effects that their decisions and actions will have on their health conditions.
According to the study, many patients recognize the fact that their behaviors have attached impacts on their health conditions. Individuals with diabetes and depression indicated a larger percentage of this knowledge. Unfortunately, this aspect does not put into practice by most patients. A good number of the respondents indicated they were not in a position to incorporate the adjustments in their health behaviors. This, however, is a result of a lack of effective policies and motivational backing, which was necessary in helping them adapt to these adjustments. There was also a difference in the personal attitude and perceptions of successful and unsuccessful at the diagnosis time. According to the survey, respondents who perceived themselves as successful in their fight with chronic illnesses made earlier plans at the time of diagnosis to make changes in their lifestyles and sought for significant knowledge and information about their wellbeing. On the other hand, less successful patients were most likely to be ignorant, adopt avoidant strategies, and develop wishful thoughts about their condition, which brings about disappointments. This implies that the diagnosis time is significant. At this stage, medical practitioners should sieve the opportunity to instill a positive outlook on patients to help them develop the right course of action in their fight with the chronic illness.
5.2 Patient-Physician Relationships
The majority of individuals with chronic illness labeled their connection with medical practitioners as there was a collaborative treatment. According to patients who viewed themselves as successful, this was the approach they adopted. The relationship between patients and physicians is all about prolific and effective interchange of important information. Individuals who perceived themselves as comfortable living with the conditions indicated that their physicians often gave them reading materials about chronic conditions with no positive perception. A majority of the medical practitioners however opted to play a significant role in the management of the chronic illness by deliberating on better options with patients and their family members in order to establish quality treatment decisions. There were no big divergent perceptions about this on the practitioners’ side. They helped patients in providing specific information about particular diseases and setting goals and expectations together with patients.
5.3 Supposed Patients needs
In order to effectively manage their illness, individuals with chronic condition repeatedly pointed out information access and knowledge as the main elements enhancing them to handle their situations. Most patients depended on reading materials about their conditions, which enabled them to adjust their lifestyles with regards to their health conditions (Porter, Pabo, & Lee, 2013). A number of the respondents attested to the fact that their main weapons after diagnosing their condition was access to relevant information addressing the illness. In instances where there was no information, they raised many questions and called for guidelines to other better treatments.
5.4 Physicians Opinions
According to medical practitioners, individuals with chronic conditions benefited much from the support they received from their family members and friends. The support played a major role in motivating patients to adapt to adjustments in their lifestyles in order to manage their chronic conditions. However, this does not mean that the absence of this support would undermine patient’s efforts. The medical practitioners indicated that the main challenge chronic condition patients’ face is the lack of motivation and willpower, which is as a result ofbegative attitude. In terms of treating chronic conditions, medical practitioners attest to the fact that they do not have deep information to handle chronic conditions within a short time. They are used to offering patients the long-term care about chronic conditions, which initially they were not well informed to handle.
5.5 Importance of Satisfaction
Chronic condition patients and medical practitioners establish a connection, which acts as the basis for effective chronic care. Good and longer relationship enables patients to raise all their concerns and queries about their health conditions comfortably, which helps in improving their lives. This is also significant in boosting chronic care as physicians get more information about patients that help them address their cases effectively, for instance, family history.
5.6 Anticipated Physician Qualities
The most rated requirements for medical practitioners according to chronic patients are being understanding, informative, and collaborative. Individual patients value medical practitioners who offer them understandable explanations. This therefore calls for the physicians to be more professional and well informed to provide relevant and significant information. Furthermore, the medical practitioners should be able to listen and effectively cooperate with patience in order to listen to them and gain their confidence and trust. An amalgamation of these two skills, technical and personal, enhanced personal satisfaction among patients in the chronic care. Patients are also expected to provide important information to physicians and listen carefully in the process of chronic care.
6.0 Summary of Findings
The most underlying factor in chronic care is the relationship between the patients and medical practitioners, which is aligned to information exchange. Physicians note the fact that chronic care begins with an adjustment of lifestyles for chronic patients. On the other hand, individuals who are at the center adapting to chronic care adjustments need to have effective knowledge of the same, which is ideally received from the physicians. Alternatively, some patients have incorporated the use of online information. However, this approach lacks the personal touch and motivation to fully address chronic care, thus being less reliable. Individuals with chronic condition will most often need the quiet personal touch and dialogue with medical practitioners in undertaking chronic care. Patients who get satisfaction from physicians will have a low chance of login into the internet to get more information.
Furthermore, individuals who succeed in managing their chronic conditions acknowledge the significance of their behavior, get relevant information, and make necessary adjustments in changing their lifestyles to factor in chronic care management. The success of these individuals is also enhanced by the contribution and motivation from family members and friends. The patients are never swayed by other disorders, such as moods or mental concerns. They perceive their chronic condition as part of their lifestyle.
In chronic care, physicians find it necessary to provide more information and instructions. Chronic care, unlike acute care, results in pressure while handling patients, specifically health behaviors and attitudes, which may undermine the success of patients in chronic care. The medical practitioners’ hope is that more tools and equipment will be available to strategically enhance compliance mechanisms by patients in addressing their chronic condition care.
7.0 Recommendations
According to the investigation, a larger percentage of medical practitioners admitted that they had not received adequate training and instructions on dealing with chronic care. Endocrinologists and psychiatrists emphasized this requirement. The medical model for training of healthcare practitioners has always been predominantly concentrating on diagnosis and symptom reprieve rather than care management, which is key aspect in chronic care. Furthermore, the healthcare sector should also come up with established physicians who will be oriented specifically to deal with chronic condition management in order to help individuals with chronic disorders.
Individuals with chronic conditions should also be provided with vital information and education on chronic care management. This information is crucial to patients since it is all they look for. In as much as medical practitioners are well placed to give the much esteemed information, patients can also be enlightened through information from family members, friends and the internet. The healthcare sector can also come in and provide health information about chronic conditions and their management to all its citizens that will be beneficial to everyone in society especially the patients. Physicians should also be provided with better mechanisms and equipment’s in providing information to chronic patients especially with the increase of patient’s population since they play the fundamental role in chronic care management (Petterson et al., 2012).
Chronic care management also requires delivery system structure management. At times, medical practitioner’s job description ends at diagnosis and treatment besides many other patients that need to be attended to. However, the physicians are required to provide information, educate and make a follow up progress to patients with medical conditions. This becomes difficult for them thereby requiring the services of social workers. They are significant in helping the physicians in administering some of these roles. These individuals will also be helpful in addressing and following up lifestyle aspects involved, for instance, exercise, and diet or medication compliance among others. These arrangements structures however need to be rearranged and evaluated effectively in order to ensure that patients are comfortable and access all the information and facilities they need.
In terms of handling comorbidities, which are multiple chronic conditions in an individual, new approaches should be developed in screening the condition and provide the most effective care for the patients without discriminating them.
8.0 Conclusion
Chronic care in America has pointed out at different approaches used in ensuring that the relationship between patients and medical practitioners in enhanced. This is the most efficient way in managing the conditions. They include providing prescription information, screening services, ensuring patient partnership in care, encouraging action immediately after diagnosis and early life adjustments. Chronic care action is vital in helping individuals, physicians and other medical groups in handling and managing chronic conditions.
9.0 References
Atkinson, N.L., Olinger, L., and Pan, E. (2013). Unleashing the Power of Each Individual to Manage Their Health and Partner in Their Health Care, Enabled by Information and Technology. Office of the National Coordinator for Health Information Technology, Washington, DC.
Bodenheimer, T., Chen, E., & Bennett, H. D. (2009). Confronting the growing burden of chronic disease: can the US health care workforce do the job? Health Affairs, 28(1), 64-74.
Christ, G., & Diwan, S. (2009). Chronic Illness and Aging: Section 1: The Demographics of Aging and Chronic Disease. Counsel on Social Work Education. Retrieved from http://www.cswe.org/File.aspx?id=25462
Dall, T. M., Gallo, P. D., Chakrabarti, R., West, T., Semilla, A. P., & Storm, M. V. (2013). An aging population and growing disease burden will require a large and specialized health care workforce by 2025. Health Affairs, 32(11).
Heron, M. (2013). Deaths: leading causes for 2010. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 62(6), 1-96.
Lefebvre, R. C., & Bornkessel, A. S. (2013). Digital social networks and health. Circulation, 127(17), 1829-1836.
Petterson, S. M., Liaw, W. R., Phillips, R. L., Rabin, D. L., Meyers, D. S., & Bazemore, A. W. (2012). Projecting US primary care physician workforce needs: 2010-2025. The Annals of Family Medicine, 10(6), 503-509.
Porter, M. E., Pabo, E. A., & Lee, T. H. (2013). Redesigning primary care: a strategic vision to improve value by organizing around patients’ needs. Health Affairs, 32(3), 516-525.
Rundall, T. G., Shortell, S. M., Wang, M. C., & Casalino, L. (2002). As good as it gets? Chronic care management in nine leading US physician organisations. British Medical Journal, 325(7370), 958.
Schiller, J. S., Lucas, J. W., Ward, B. W., & Peregoy, J. A. (2012). Summary health statistics for US Adults: National health interview survey, 2010. Vital and Health Statistics. Series 10, Data from the National Health Survey, (252), 1-207.
Smith, M.D. and Institute of Medicine (US) Committee on the Learning Health Care System in America.Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. National Academies Press, Washington, DC; 2013
Thorpe, K. E. (2005). The rise in health care spending and what to do about it. Health Affairs, 24(6), 1436-1445.
Thorpe, K. E. (2013). Team approach to care of chronic conditions is key to long-term health system fix. Interviewed by Lois A Bowers. Medical economics, 90(1), 58-58.
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