For patients living with a chronic disease, such as rheumatoid arthritis or osteoarthritis, learning to manage and cope with the myriad adverse symptoms that accompany these diseases is key to improving quality of life and helping reduce the cost burden of these illnesses on the healthcare system.
You Might Also Like
Explore This IssueJune 2015
Also By This Author
One important way rheumatologists can help is by referring patients to disease management programs. Such programs have been shown to improve symptoms, such as fatigue, stiffness and insomnia, and reduce hospitalization and other healthcare costs.
Also referred to as self-management programs, these programs are commonly available in the community setting in senior centers and other venues. Getting patients linked to these programs is one key challenge that, if met, could expand the benefits of these programs to more patients who need them.
What Disease Management Programs Offer
The Chronic Disease Self-Management Program (CDSMP) developed at Stanford University, Palo Alto, Calif., is frequently used in rheumatology and endorsed by the Centers for Disease Control and Prevention (CDC) for people with arthritis, says Leigh F. Callahan, PhD, Mary Link Briggs Distinguished Professor of Medicine and Professor of Social Medicine, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, N.C. This program, along with other evidence-based programs for self-management, is also endorsed and often funded by the National Council of Aging (NCOA) for use in the public health arena and for delivery at the state level through area agencies on aging.
“Disease management programs are a mechanism for having people gain skills, competence, and confidence in their ability to manage their chronic illness and symptoms, such as managing fatigue and pain,” Dr. Callahan says, adding that the programs are designed to help individuals manage their disease along with, or as a supplement to, the treatments they receive from their clinicians.
In addition to improving the quality of life for people with chronic diseases, recent data also show the effect of these programs on reducing healthcare costs. A 2013 published study that looked at reductions in healthcare utilization among more than 1,000 community-dwelling CDSMP participants from 22 organizations in 17 states found a significant reduction of 5% in emergency room visits at both six- and 12-month assessments, as well as a 3% reduction in hospitalizations at the six-month assessment.1 The study estimated a national savings of $3.3 billion if only 5% of adults with one or more chronic diseases participated in this type of program.
Connecting Patients to Programs
A key challenge for rheumatologists is connecting their patients to these programs. “There is a disconnect in most places between clinicians and these programs,” says Kate Lorig, MD, professor emeritus, Medicine—Immunology & Rheumatology, Stanford School of Medicine, Palo Alto, Calif., who helped develop the CDSMP. “Clinicians don’t have enough time to go hunting around for the programs, and systems are not in place for clinicians to do this sort of referral on a patient-by-patient basis.”