PD24 Innovation In Chronic Obstructive Pulmonary Disease Care: Cost Effectiveness Of A New Self-Management Maintenance Program In The United Kingdom
Anil GumberAmir KhanMatthew RichardsonAnnabel HongClaire M. NolanKhaled AlqahtaniWilliam D‐C ManSally SinghFrank W. SmartChris HedgerLinzy Houchen-WoolloffAla Szczepura
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Introduction Innovation is needed for the growing number of patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) is effective in improving exercise tolerance and quality of life, but these benefits do not appear to be sustained. This highlights the need for cost effective methods to maintain benefits on completion of therapy. The findings of a large trial from the UK are reported. Methods A two-center randomized controlled trial of patients discharged from PR compared the costs and benefits of PR maintenance with standard care. National Health Service (NHS) resource use, personal expenditure, and societal costs were recorded over one year, and bottom-up costing was undertaken for the PR maintenance program. Changes in health-related quality of life were recorded using the EQ-5D-5L, and differences were compared with the level identified as significant for COPD. A cost utility analysis was undertaken from an NHS perspective; uncertainties in cost and outcome data were incorporated into a sensitivity analysis. Cost-effectiveness ratios and cost-effectiveness acceptability curves (CEACs) were computed. Results The study included 116 patients who had finished PR within the last four weeks. The economic analysis showed that mean healthcare costs per patient for PR maintenance were approximately GBP139.72 (EUR165.57) lower than for usual care. The observed 0.118 advantage in mean quality-adjusted life-years (QALYs) (p<0.05) was above the threshold (0.051) for COPD significance. CEACs indicated there was a 97 percent chance of achieving GBP20,000 (EUR23,699.80) per QALY (NICE acceptance level ≤GBP30,000 (EUR35,549.70). Patient and societal costs increased this percentage. It was estimated that if patients with COPD completed a maintenance program following PR, the NHS could save up to GBP28.6 million (EUR33.89 million). Conclusions Our findings confirm that a structured PR maintenance program is highly cost effective in extending the benefits of short-term PR. The trial, undertaken during COVID, also signals the potential for emerging digital innovations to provide future transformative change in delivering self-management programs to sustain health and reduce NHS costs for people living with chronic conditions.Keywords:
Disease management
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Chronic disease is increasing as a percentage of all illnesses in Australia's health care system, in part because of the ageing of the population. New strategies are required to help manage these often incurable diseases. The general practitioner is well equipped to provide management expertise for chronic disease, provided he or she has access to community based allied health professionals.
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Background: In addition to good management by the doctor, for type 2 diabetes mellitus (DM2), good self-management is crucial for preventing debilitating and costly long term complications. However, it is not yet clear what influences disease self management. It is known that knowledge of the disease plays a role: more knowledge of the disease is related to better selfmanagement, which is related to better health-outcomes. Better communication with the doctor in turn leads to more knowledge of the disease. One of the underlying mechanisms may be perceived quality of care. It is not known whether high perceived quality of care leads to better disease management and to better disease outcome This study examined whether positive care experiences with the general practitioner (GP) and /or knowledge of the disease are correlated with better disease outcome. Methods: The Consumer Quality Index (CQI) Diabetes questionnaire, measuring patient experiences and knowledge of the disease, was sent to 3,384 DM2 patients in 21 GP practices in order to assess perceived quality of care and knowledge of the disease. In addition, medical data were retrieved from GP’s medical records to assess disease outcomes. Experiences from the CQI on diabetes-specific communication were compared to disease outcomes and knowledge using regression analyses. Results: Patients with positive care experiences had better disease outcomes for a number of DM2-related measures, e.g.better creatinine levels, less hypertension, less manifest cardiovascular, cerebral and renal complications, and they exercised more. They were also better informed about the disease. Patients with more knowledge of the disease also showed better outcomes. Conclusions: High perceived quality of GP care and knowledge of the disease are both related to better disease-specific outcomes. High perceived quality of care is also related to a better understanding of the disease. Therefore, it is crucial for the GP to ensure the patient has knowledge of the disease, and also to invest in increasing the quality of care as perceived by the patient. Both will lead to better disease outcome. (aut. ref.)
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China's limited community medical resources cannot meet the needs of chronic disease prevention and treatment due to the rapidly growing ageing population.The improvement and long-term maintenance of patient's self-management is essential for chronic disease management.In view of chronic disease management having a characteristic of being carried out in the family for a long time in recent years, it has been proposed that the key role of spouse in the management of chronic disease should not be underestimated.This article reviews the epidemiological evidence, theoretical foundations and interventional findings of elderly couples' collaborative management with chronic diseases, aiming to provide the evidence for efficiently conducting chronic disease management for community-dwelling older adults.
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Spouses; Chronic disease; Disease management; Lifestyle
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Disease Management (DM) is a system of coordinated healthcare intervention and communications for populations with conditions in which patient self-care efforts are significant. e-DM makes reference to processes of DM based on clinical guidelines sustained in the scientific medical evidence and supported by the intervention of Information and Telecommunication Technology (ICT) in all levels where these plans are developed. This paper discusses the design and implementation of a e-DM system which meets the requirements for the integrated chronic disease management following the recommendations of the Disease Management Association and the American Heart Association.
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In Australia chronic diseases currently account for 70% of the total burden of ill health and a correspondingly high proportion of health care expenditure. Even with recent improvements in chronic disease management, there is a significant gap between recommended and actual treatment, care coordination and provision of supports for self management. In Wagner's Chronic Care Model, a chronic disease management register can facilitate individual and population management of chronic diseases and help build partnerships for collaborative diagnosis, treatment planning and care tracking. Various chronic disease management programs currently use chronic disease management registers as a component of their clinical information management systems and there is some evidence that these have contributed to improved chronic disease management. Such registers are relatively uncommon in Australia but may soon proliferate, in part because they have been called for by the National Chronic Disease Strategy. This paper presents suggestions for optimising the utility of chronic disease registries and advancing the agenda for reform in chronic disease management in Australia.
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Management of disease in wild animals may be done because the disease is having a negative effect on a valued species, because the disease is a risk to humans or domestic animals, or because there is public pressure to do something about a perceived problem. Management may take four general directions: a decision might be made not to intervene, in which case the disease will continue; or intervention could be directed at preventing disease occurrence, reducing the frequency or impact of the disease, or complete eradication of an existing condition. Within these general directions, effort might be directed at attacking the disease agent, altering the environment, manipulating the host population, or changing human activities. Most programs involve some combination of techniques that includes public education. Disease management requires input from many disciplines; the system used in Canada to link veterinary and wildlife management expertise through the Canadian Cooperative Wildlife Health Centre is described.
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By reviewing the concept of disease management and disease managers, the admission qualification of disease managers, the role and specific work of disease managers in chronic disease management, this paper aims to provide a theoretical basis for disease managers to develop in a deeper and higher direction in chronic disease management, and to further improve the value of nurses themselves and the direction of specialty development.
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Disease manager; Disease management; Chronic diseases; Review
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Objective To observe the effect of health management and disease management comprehensive prevention for chronic diseases in communities. Methods A total of 100 patients with chronic diseasewere given health management and disease management comprehensive prevention,were compared the improvement of the symptoms after comprehensive prevention. Results The blood pressure and blood glucose of 100 patients with chronic disease were effectively controlled after intervention,the patient's treatment compliance and awareness of disease knowledge were also significantly increased. Conclusion Health management and disease management comprehensive prevention for chronic diseases in communities can obtain the obvious effect.
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