Managing care of chronic diseases. Towards Health Care System redesign?

Abstract

In the last decades, different causes have been increasingly influencing the effectiveness and efficiency of the health care system. Consequently, dissatisfaction has grown in patients, health care providers and payers. Thus, it is necessary to stop dealing with a straining system that does not resolve the underlying problems and to try to redesign it. In this essay we focus on the analysis of accessibility problems and bad results in quality of care. A new paradigm adopted by the Hospital Italiano’s Health Care Plan is based on 6 pillars: 1) Activities for self-management and self-care of patients. 2) Clinical decision support systems, clinical guidelines and expert opinions. 3) Community resources. 4) Information and surveillance systems. 5) Organizational changes and redesign of the attention system. 6) Cultural changes and health care system finance. Our experience shows that this paradigm change is not only better from a theoretical point of view, but also from our daily practice and scientific research. It is based on the development of a multidisciplinary ambulatory team (with primary care physicians, specialists, nurses, social assistants, monitors, educators and program coordinators). Also very important aspects are: patient empowerment and the use of information systems for patient control and surveillance (specially for those who do not assist to routine care or whose chronic diseases have bad evolution) to offer patients what they really need and not only what they demand.