Chronic Disease Management
Chronic Illness in America has become a large issue and burden on our nation's public health systems. We have such a strain on our nations systems because our health care structure is not built around the need of the patients. How many patients become ill between the hours of 9am and 5 pm Monday thru Thursday? Not many, and with Cardiovascular Disease, Diabetes, Chronic Obstructive Pulmonary Disease, and Hypertension on the rise in America it is concerning that our approach to health care has not changed.
Hospitals have become more than just Emergency care and surgeries. For many Americans the hospital emergency room is used as a means for treatment of their unmanaged chronic illnesses that have grown to become acute exacerbations. Many of times these hospital admissions become full health work ups to identify the root of the symptoms and manage the symptoms accordingly. Many times these work up include expensive tests that may have been done previously at another location. The hospital attending physicians have to use certain diagnostic procedures and tests to rule out possibilities.
I feel that if physician had "extenders" these would be nurse practitioners and physicians that would take on only patients who have three or more chronic illnesses or have been hospitalized more then once within a six month time frame. These physician extenders would have a greatly reduced patient load and would be able to prevent unnecessary hospitalizations.
Patient to physician relationships play a very important role in this change in how we practice medicine. The patient would have a phone number to the "extender" giving them 24 hour access to the physician or nurse practitioner. When a patient starts to feel the red flags of an exacerbation they would call their physician and they would come to the house to administer care. Patient education is required so that they can identify the triggers that their illness may be acting up. Patient Education for Chronic Heart Failure patients is that if their belly is more swollen or feet show evidence of edema to contact "extender". The physician could administer a shot of a diuretic Lasix and prevent the process from intensifying any further.
In order for this process to work the patients would have to trust their practitioner and think of them first when they start to not feel well. By the physician having a smaller patient load they would be able to learn the triggers for the patients. The fact that the extender would be going to the patients homes they would be able to also see other environmental and social factors that an office based doc may not be able to see. Home visits will also allow a better ability to treat the illness from a physical and psycho social standpoint.
This program would likely be funded by insurance companies to reduce the unnecessary expense of hospitalizing patients repeatedly for chronic...