Chronic Condition Management & How Personalized Healthcare Helps

What is Chronic Disease Management

Chronic disease management helps to manage long-term health issues in order to make day to day functions easier. Having a personalized approach from your doctor can help control your symptoms and potentially slow down any progression.

What Conditions Qualify for Chronic Condition Management?

If you have a chronic condition such as type 2 diabetes, heart disease or depression, having a primary care physician who has time to help you and personalize your care can make a big difference. Some other chronic conditions include:

• High blood pressure
• Congestive heart failure
• Arthritis
• Asthma
• Chronic obstructive pulmonary disease
• Kidney disease
• Lipid disorders
• Thyroid disorders

Type 2 Diabetes

Consider type 2 diabetes. Current care guidelines are based on large population studies and are backed up by decades of science, yet the disease still accounts for a surprising percentage of negative outcomes like heart attacks, preventable blindness and non-trauma induced amputations. People with diabetes still die an average of six years earlier than patients without the disease.

There are two possible explanations for these discrepancies. First, patients don’t follow treatment guidelines or make lifestyle changes or physicians don’t adhere to the guidelines. Or second, the guidelines themselves are not effective even when applied under optimal circumstances.¹

There are lots of reasons why patients may not follow a generalized treatment plan for chronic care management. For example, some patients when diagnosed with a chronic condition may wish to make lifestyle changes first before adding a pharmaceutical treatment. They may not be able to afford a new prescription or be afraid to take it. Or they may be unwilling to make changes in their life necessary to successfully tackle a chronic illness.

Others may have drug interactions that make generalized treatment plans less successful.

For physicians, the complications of managing a chronic illness may not be fully understood or appreciated. Many chronic conditions are hard to control and patients may struggle to follow guidelines, especially if it interferes with their busy lives.

In some cases, a standardized approach may actually put patients at risk. Consider type 2 diabetes again. There’s good evidence that in older patients tight glucose control targets (HbA1C’s under 7 percent) ² that are effective for younger patients may actually do more harm than good.

Chronic diseases also evolve – sometimes negatively. Standard approaches to treat type 2 near disease onset are unlikely to be effective indefinitely, and physicians will need to change this as the disease evolves. In the case of type 2 diabetes, studies show that doctors who follow standardized care approaches often wait to modify a patient’s treatment regiment until the disease has substantially progressed.

What a Personalized Approach to Chronic Condition Management Looks Like

If you have a long-term health condition like hypertension, you probably play a role in managing your own health. You have some understanding of the disease and may have to manage complicated tasks, “including taking medicines properly, monitoring symptoms, adopting or maintaining healthy lifestyles, managing their emotions, solving practical problems, knowing when and how to seek medical advice or community support, and coping with the impact of the condition” on your daily life.³

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A personalized approach tailors your management approach to your personal needs. It recognizes your concerns and helps you better manage your condition.

Heart Disease

If you have heart disease, a traditional approach to managing it could include a mix of lifestyle changes and medications. Your primary care physician may recommend a different diet and more cardiovascular exercise coupled with drugs like statins or beta blockers, standard approaches to one of the most common chronic conditions in America.

A personalized approach may contain all of those recommendations, but it will also include conversations between the physician and you, joint goal setting and modifications based on your needs. For example, you may not want to adopt a Mediterranean diet recommended by many physicians; you and your physician may make changes to incorporate foods and dietary restrictions unique to you.

Personalization could even include different testing to better illuminate your heart disease risk. Your doctor may decide that you need advanced inflammation testing or more detailed cholesterol screenings beyond what a standard lipid panel provides.

Of course, personalization goes beyond just conversations and modifications. Future personalized approaches to medicine may include genetic testing. Consider heart disease again. The performance of two blood thinners — warfarin and clopidogrel — commonly prescribed to heart patients can be negatively impacted by a patient’s genetics.

Physicians in the future may perform genetic testing to personalize their approach to certain therapies.

How Personalized Primary Care Support Chronic Condition Management

Unfortunately, most primary care providers do not have time to customize their approach to chronic condition management, instead offering a “one-size-fits-all” strategy that is less effective. They may not even have time to focus on chronic condition management, sending patients with conditions that are manageable within primary care to specialists for treatment.

Studies show that when doctors have time to intensely integrate the interventions listed above, outcomes are better.

Because they see fewer patients in their primary care practices MDVIP-affiliated physicians have the time to personalize treatment for chronic conditions. They have time to engage with patients. They have time to find out what treatments work best for individual patients and adopt them. They have time to work with other specialists.

Selected Sources

1. Raz, I., Riddle, M. C., Rosenstock, J., Buse, J. B., Inzucchi, S. E., Home, P. D., Del Prato, S., Ferrannini, E., Chan, J. C., Leiter, L. A., Leroith, D., Defronzo, R., & Cefalu, W. T. (2013). Personalized management of hyperglycemia in type 2 diabetes: reflections from a Diabetes Care Editors' Expert Forum. Diabetes care, 36(6), 1779–1788.

2. Riddle, M. C., Ambrosius, W. T., Brillon, D. J., Buse, J. B., Byington, R. P., Cohen, R. M., Goff, D. C., Jr, Malozowski, S., Margolis, K. L., Probstfield, J. L., Schnall, A., Seaquist, E. R., & Action to Control Cardiovascular Risk in Diabetes Investigators (2010). Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial. Diabetes care, 33(5), 983–990.

3. Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long‐term health conditions. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD010523. DOI: 10.1002/14651858.CD010523.pub2