http://bmj.com/cgi/content/full/324/7348/1237
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in Developing Countries International
health Organization
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Jo Whelan London
Primary care providers in developing countries are ill equipped to deal with chronic conditions, a new report from the World Health Organization says.
Defined as health problems that persist over time and require some degree of healthcare management, these conditions will be the leading cause of disability worldwide by 2020, it adds. Examples include diabetes, heart disease, depression and AIDS. These pose public health and economic threats to rich and poor countries alike, the report says.
The prevalence of chronic conditions is rising because of increased longevity, urbanisation, unhealthy lifestyles, and the spread of smoking. Yet healthcare systems throughout the world have been developed mainly to treat acute conditions.
The report points out that this emphasis on acute care is no longer adequate to address changing needs. It warns that as long as the acute care model dominates, expenditure will continue to rise without corresponding improvements in populations’ health status.
The WHO believes that healthcare systems must be redesigned to manage long term health problems more effectively. It proposes a framework centred on the "healthcare triad," a partnership between patients and their families, healthcare teams, and supporters in the community.
Because managing chronic conditions involves behavioural and lifestyle changes, patients must be empowered to take a central role in their own care. Healthcare staff will need to be skilled in counselling and behavioural change techniques.
The report also calls for increased emphasis on prevention: most chronic conditions, and many of their complications, are preventable. The report says policy makers have the power to reduce the impact of chronic conditions significantly.
It puts forward eight essential elements for action:
· Supporting the shift towards chronic care;
· Securing political commitment and consensus among stakeholders at each stage;
· Building integrated rather than fragmented health services;
· Focusing on health implications in other sectors, such as labour law;
· Encouraging evidence based and team approaches;
· Centring care on the patient and family;
· Providing services and support in the community; and
· Emphasising prevention.
It cautions against simply pouring more money into already ineffectual systems but says that shifting from an acute to a chronic care model can maximise the returns achieved from limited resources.
"The idea that we must increase the focus on chronic conditions is not new," comments Anthony Harrison of the King’s Fund. "Certainly in the developed world, everyone recognises that this is the way to go. But it takes a very long time to shift healthcare systems from one model to another."
Innovative Care for Chronic Conditions: Building Blocks for Action can be accessed on the WHO’s website at www.who.int/ncd/chronic_care/index.htm
The BMJ is publishing a theme issue on managing chronic diseases on 26 October. The contact editor is Dr Trish Groves, who can be contacted at tgroves@bmj.com
Competing interest: The BMJ Publishing Group has a joint
venture with WHO, the Institute for Healthcare Improvement, and the MacColl
Institute for Healthcare Innovation to produce a website for all those concerned
to improve the care of patients with chronic conditions.
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Collections under
which this article appears:Medicine
in Developing Countries International
health Organization
of health care Long
term care |
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