Implementing the Chronic Disease Self Management Model in Vulnerable Patient Populations: Bridging the Chasm through Telemedicine

Abstract

Vulnerable patient populations include those with chronic diseases, disability, the elderly, minorities and persons with limited health literacy. According to Healthy People 2000, despite recent progress in health care, there is a stagnation or decline in health care outcomes in these vulnerable patient groups. With the world population aging and the number of those over the age of 60 expected to grow to almost 2 billion by 2050 the prevalence of Chronic Disease (CD) will rise. So will the economic cost which currently is substantial and accounts for 46% of the global disease burden. Specifically in the United States, Chronic Diseases (CD’s) will be responsible for 78% of all medical expenses. Unfortunately, the demographic imperatives of an aging society with the concomitant rise in disease burden will coincide with a decreasing provider base (Wooten et al., 2006). This will necessitate the adoption of different patient management models, to ensure cost effective patient monitoring within a continuum of care. Chronic Disease Self Management Programs (CDSMP) based on the Bandura’s self-efficacy theory (Bandura 2004) focuses on teaching patients coping skills to include disease monitoring and understanding, skills to continue with normal living and strategies to improve emotional well being. Based on the Chronic Care Model, optimal care is achieved when a prepared, proactive practice team interacts with an informed, activated patient (Bordenheimer et al.2002). In the new paradigm patients with CDs become their own care givers, with health care providers acting as consultants in a supporting role. The Institutes of Medicine Report “Crossing the Quality Chasm” (1998) advocated continuous healing relationships, customized care with the patient in control, and an information system that flows freely to facilitate evidence based decision making. To achieve this, Healthcare Systems will have to shift from a Provider Centered to a Patient Centered System within the concept of Advanced Patient Centered Medical Homes, where patients are empowered as partners. The question therefore is can Telemedicine (TM) bridge the chasm by empowering patients, improving and supporting equal access, enhancing capacity, improving quality and cost effectiveness, reducing disease burden and supporting decision making, especially in vulnerable patient populations who have the