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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.
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.”
Dr. Lorig urges clinicians, therefore, to find a program in their local area and input the information once in the electronic medical record system so that it appears automatically on the patient’s discharge summary.
Currently, she says, there are about 1,000 sites in every state except Wyoming that offer these programs. She says a good place to start your search for a local program is to call the National Association of Area Agencies on Aging; other resources are listed below:
- National Association of Area Agencies on Aging
- Stanford Patient Education Research Center
- Contact Dr. Kate Lorig
Another resource Dr. Lorig suggests is the free online program offered through the Arthritis Foundation.
Disease management programs are a mechanism for having people gain skills, competence & confidence in their ability to manage their chronic illness & symptoms.
Dr. Callahan agrees that providing the contact information for the program on the discharge summary would also make the referral seamless and lift the burden of finding a program off the shoulders of the patient, where it currently lies.
She emphasizes the need for clinicians to improve their participation in referring patients to community sources, such as disease management programs, citing a model in the Institutes of Medicine report that recommends more interaction with community intervention and clinical intervention.2
Mary Beth Nierengarten is a freelance medical journalist based in St. Paul, Minn.
Resources on Disease Management Programs
- Chronic Disease Self-Management Program (CDSMP)
- U.S. Department of Health and Human Services. Administration for Community Living. Administration on Aging (AoA). American Recovery and Reinvestment Act Communities Putting Prevention to Work: Chronic Disease Self-Management Program
- Centers for Disease Control and Prevention (CDC). Arthritis Foundation. A National Public Health Agenda for Osteoarthritis 2010
- Osteoarthritis Action Alliance
- Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (part I). Health Promot Pract. 2005;6(1):37–43.
- Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (part II). Health Promot Pract. 2005;6(2):148–156.
References
- Ahn S, Basu R, Smith ML, et al. The impact of chronic disease self-management programs: Healthcare savings through a community-based intervention. BMC Public Health. 2013 Dec 6;13:1141.
- Living Well with Chronic Illness: A Call for Public Health Action. Institute of Medicine. The National Academy Press. 2012 Jan 31.