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High quality care for people with chronic diseases

2005; BMJ; Volume: 330; Issue: 7492 Linguagem: Inglês

10.1136/bmj.330.7492.609

0959-8138

Trish Groves, Edward H. Wagner,

Diabetes Management and Education

High quality care for people with chronic diseasesWhat patients with chronic conditions really need W hat do patients with chronic conditions need?Worldwide, the straight answer must be a better life with freedom from poverty, hunger, and violence, and with the ability to read, work, and choose how many children to have.As for health, there is still much to do to prevent chronic disease through improving maternal and infant health, tackling infections, treating depression, cutting rates of smoking, and improving diet and levels of physical activity.These are big themes needing concerted responses, and all are debated regularly in the BMJ.This week, however, the BMJ is homing in on the practicalities of what researchers, doctors, and nurses and-most importantly-patients can do to make living with chronic disease more rewarding.This is the fourth issue the BMJ has dedicated to the topic of managing chronic diseases (see http://bmj.com/misc/fcissues.shtml for previous issues).Why have we given so much space to this topic?Firstly, chronic diseases are now the main cause of death and disability worldwide.According to the World Health Organization, non-communicable conditions, including cardiovascular diseases, diabetes, obesity, cancer, and respiratory diseases, now account for 59% of the 57 million deaths annually and 46% of the global burden of disease. 1 Less developed countries now face a huge double burden of acute and chronic disease.For example, WHO estimates that the number of people with diabetes will have risen by 195% in India during 1995-2025 to reach 57.2 million, while Pakistan is expected to have about 14.5 million people with diabetes by 2025.w1 Less developed countries are rising to this challenge, and the BMJ would like to publish much more evidence on managing chronic conditions in less developed countries.This week Ramaiya brings encouraging news on diabetes services in Tanzania, 2 and Pruitt and Epping-Jordan discuss the essential changes to the training and practice of health workers that chronic disease care requires and which are already underway in countries such as Eritrea and Sudan. 3Tang, however, discussing hypertension and cardiovascular disease in China, brings a note of warning: what works in countries with well resourced health services may simply be too expensive. 4ut there is also much more to be learned about coping with and managing these conditions in the richer world.Firstly, how can the quality of existing care for chronic diseases be improved?One strategy is to