Major Health Issues in Nova Scotia: An Environmental Scan

# Reference Brief Notes
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with evidence-based treatment advice.
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Historically, management of chronic diseases such as hypertension
has tended to be reactive, with patients being passive recipients of
care. In recent years, the chronic care model has been developed and
implemented in many jurisdictions to ensure optimal, proactive care
of people with chronic conditions. The model and its principles
address the infrastructure and support that is necessary to enable this
high-quality care. The role of the patient, primary care team, system
and community are all addressed in this model. Experience suggests
that application of chronic disease management principles to
hypertension can result in significant benefits to all concerned.
The fastest-growing methodology for disease management outcomes
measurement is valid, transparent, easy to apply, and freely available
in the public domain and this article. It measures the actual goal of
disease management, which is to reduce the rate of adverse events
associated with the disease(s) being managed. Changes in this rate can
be translated into a return on investment using some explicit
assumptions about comorbidities and episode costs. Outcomes
measured in this way show that in the health plan community as a
whole, disease management in the broadest sense is working, as
measured by the relative stability in the rate of adverse medical events
closely associated with common chronic disease during this decade of
increasing prevalence of most of the common chronic conditions.
We present the Interactive Biopsychosocial Model (IBM). The IBM
argues for a reorientation in biomedicine where research, education,
and clinical practice: (1) address health in addition to illness; (2) aim
to decipher interrelated biophysical, psychocognitive, and social
processes in health and disease, rather than seek a single root cause;
and (3) take into account the social networks of the individual to
achieve, maintain, and maximize health and well-being for individuals,
their significant others, and society. The model provides a dynamic,
dyadic, framework for building scientific hypotheses about the
etiologies and consequences of health, well-being, and disease
throughout the life course.
The Program of All-inclusive Care for the Elderly (PACE) grew out
of a small community organization in San Francisco and has been
replicated by non-profit organizations in a number of other
communities across the country. The authors review the successes of
PACE as reported in the literature and discuss reasons for its limited
growth as well as its significant influence on state and federal long
term care policy.
In this article, the author’s discuss how one might use the common
sense model of self-regulation (CSM) for developing interventions for
improving chronic illness management. They describe two separate,
ongoing interventions with patients with diabetes and asthma to
demonstrate the adaptability of the CSM. They also discuss three
additional factors that need to be addressed before planning and
implementing interventions: (1) the use of top-down versus bottomup
intervention strategies; (2) health care interventions involving
multidisciplinary teams; and (3) fidelity of implementation for tailored
interventions.
Effective psychological and pharmacological treatments are available,
but for depressed older adults with long-term physical conditions, the
outcome of routine care is generally poor. This paper introduces the
chronic care model, a systemic approach to quality improvement and