Main description:

'In the next 20 years, the Department of Health in England expects the number of those aged over 80 years to double and the number of people with a long-term condition to increase by 3 million. The same trends apply in all developed countries. While there is nothing we can do to alter these facts, there is much we can do to address the way we conceive of and manage chronic disease.' Mike Pringle, in the Foreword In this ground-breaking new work, Patrick J McEvoy connects with healthcare professionals, patients and illness to present an entirely new way to address chronic disease management. By reflecting on the very nature of chronic disease, rather than focusing on its consequences, the book sheds new light on the complex realities of general practice, explaining the intricacies of community medicine, and its relationship with both sociology and epidemiology. Highly practical in its approach, the book offers a generic paradigm of chronic disease, a trajectory-based model of clinical management and a curriculum for chronic care.
It provides thought-provoking reading for all health and social care students and professionals, postgraduate trainees in general practice and their trainers seeking inspirational new ways to manage chronic disease. 'For those who aspire to achieve optimal outcomes, this book is their invaluable guide. It presents an evidence-based, generic profile of chronic disease as well as putting a recognisable face on the main players - the patients, their carers, the clinicians, all involved in training and the health system...A timely analysis of current issues in chronic disease as well as a unique teaching and learning resource.' Mike Pringle, in the Foreword

Contents:

Foreword vii About the author viii Acknowledgements ix Introduction: chronic disease, its natural history and ecology 1 But, is it possible to get excited about chronic disease? 3 Suggestions for using this book 4 So, what's on offer? 4 References 5 1 Chronic disease: what's so special about it? 6 Chapter overview: executive summary 6 Chronic disease management in a nutshell 8 Are you interested in chronic disease? 12 How many chronic diseases do you have? 13 Scenario: a consultation 17 The impact of chronic disease 18 Some characteristics of chronic disease 23 Disability as a chronic condition 31 Scenario: tutorial time 32 Conclusion and refl ection 35 References 36 2 The story of chronic disease (the disease complex) 38 Chapter overview 38 Scenario: story time 39 Chronic disease, the enemy within 40 Profi ling chronic disease: chronic versus acute disease 42 The natural history of chronic disease: the life cycle of the Dragon 44 Models of disease 47 Co- morbidity and multi- morbidity 51 The ecology of the Dragon 52 Entering the Dragon's den 54 Laying the foundation stone of the chronic disease paradigm 65 Summary: the story to date 66 A bit of epidemiology 67 Conclusion and refl ection 77 References 78 3 The journey through chronic disease (the patient complex) 80 Chapter overview 80 What is it like to live with chronic disease? 81 Scenario: a case study 82 The patient's journey through chronic disease 86 The early days: the importance of diagnosis 88 The middle passage: illness progression and transitions 95 Advanced disease: the palliative phase and end of life 99 The clinician's journey with the patient 101 The sociology of health and disease 104 The healer role 114 The social determinants of health and disease 119 Scenario: a refl ective learning diary - patients, their carers and advocates 126 Conclusion and refl ection 129 References 130 4 Care of the chronic sick: the community complex 134 Chapter overview 134 Who cares? 135 Scenario: the village 136 Care in the community 139 Levels of care: how much, who cares, where and at what cost? 140 Issues in care: autonomy, advocacy and agency 151 The expert patient and self- management 152 The caring professions 156 A historical note on UK systems of health and social care 158 Scenario: a practice policy on carers 159 Conclusion and refl ection 161 References 162 5 The clinical complex: the general practitioner and chronic care 164 Chapter overview 164 Part One: general practice as the focus of chronic disease management 165 What GPs do: fi shing or fi ltering? 167 General practice: concept and method 171 Scenario: a multidisciplinary learning exercise 182 Designated clinics in general practice 183 Health promotion and health education 188 Scenario: a review of progress with our once new trainee 191 Part Two: developing the clinical complex 192 Electronic media and general practice 192 Internet interventions and patient self- help 196 Integrated care 197 Commissioning chronic care 203 The quality agenda 205 Management and governance 216 Evidence, guidelines and audit 218 Conclusion and refl ection 225 References 226 6 A chronic care revolution: service redesign and the policy complex 230 Chapter overview 230 Health policy for long- term conditions: global, national and local 231 WHO policy and chronic disease management 234 Unpacking health policy 237 Building blocks of the chronic care revolution 243 Scenario: a coffee break 251 Ten characteristics of an effective health service 252 The four strategies 261 Social policy and chronic care 264 A 12- step rehabilitation programme for health systems 265 Conclusion and refl ection 266 References 267 7 The learning and teaching complex through the chronic disease paradigm 270 Chapter overview 270 Medical education in primary care: a UK profi le 271 How is chronic care taught? 273 The chronic disease paradigm 276 The chronic disease paradigm unpacked 278 Chronic illness care: a summary for students and trainees 289 Chronic illness care: a new specialism 292 Scenario: Refl ections of a trainer - learning through chronic disease 296 Conclusion and refl ection 301 References 301 8 Meeting the challenges of chronic care 303 Chapter overview 303 We have a problem on our hands! 304 The National Health Service is well placed 306 Is general practice meeting the challenge of chronic disease? 307 A menu of tactical responses 310 Taking stock of UK primary care 311 Slimming practice, weight reduction and noise abatement 314 Chronic care guidelines for the general practitioner 319 Conclusion 321 References 323 Appendix 1: A simple integrated chronic disease management paradigm 325 Appendix 2: The trajectory model of chronic disease 327 Appendix 3: Modifi ed pyramid of levels of care 328 Index 329