Long-term diseases are the leading cause of mortality and disability in the United States. According to the Centers for Disease Control, about six in ten American adults have at least one chronic illness, and four in ten have multiple chronic health conditions.

These life-changing illnesses will require ongoing care for the foreseeable future, and it’s critical that patients receive the support they need. That includes resources and information for day-to-day management of their condition, not just medical emergencies.

But that’s easier said than done.

The problem is that chronic conditions are notoriously difficult to manage. That’s true for several reasons:

  • Most current care models are designed for acute illness.
  • Patients are not always active participants in their care.
  • Chronic illness requires day-to-day care outside the physician’s office.

The majority of effort required to manage a chronic illness does not occur inside a medical practice. Instead, patients must take charge of their own care every day. That may include checking blood sugar levels, administering insulin injections, taking medication, or practicing lifestyle changes. When patients adhere closely to the care plan, they enjoy better long-term outcomes.

But lack of patient education, motivation, or support can undermine even the best care plan. That’s why strategic chronic care management is essential for patients with diabetes, heart disease, Alzheimer’s, and other chronic diseases.

Empowering Patients With Patient-Centered Care

To achieve the best outcomes, patients must be actively involved in their own care. Let’s look at six ways to achieve the best results for patients with chronic conditions.

1. Adopt a Patient-Centered Approach
A patient-centered approach looks at the patient’s health and experience holistically. Rather than addressing just the current diagnosis, it also considers the patient’s life circumstances, preferences, other health conditions, and concerns. The goal is to customize the care plan to the patient’s unique situation rather than providing the same information or care process for every patient. Some patients may require more communication and emotional support, while others may need more educational resources or connections to community resources. As you help patients improve health literacy and get the assistance they need, they will feel more confident about their own role in their care.

2. Collaborate With Other Providers
Patients with chronic illnesses often have complex medical needs requiring the intervention of more than one healthcare provider. Unfortunately, this often leads to fragmented care that may hinder follow-through. Promoting communication and collaboration among providers improves the quality of care received, and it helps build trust with your patients.

3. Involve Family Caregivers
The majority of care for chronic illness takes place outside of a healthcare facility. That means patients and their family caregivers ultimately carry the greatest burden of care. Think of chronic care management as a team effort, with the patient at the center. The team must include not only the patient and all of his or her healthcare providers, but also any family members involved in providing or overseeing care. As you educate and communicate with family caregivers, you can improve the daily experience of patients who rely on their loved ones for assistance and support.

4. Address Emotional As Well As Physical Needs
Being diagnosed with a chronic illness can cause anxiety and stress for patients, especially if they don’t feel supported. These emotions may be centered on fear of pain, disability, medication side effects, diminished physical ability, loneliness, or financial concerns. Emotional dynamics have far-reaching ramifications, and they should be included in the care plan just like the physical effects of the disease.

5. Empower Patients with Tools for Daily Support
Make it as easy as possible for patients to interact with healthcare providers, educate themselves about their illness, and find answers to their questions. You can improve access to information and care with tools such as online scheduling, patient portals, educational resources, communication tools like message centers or online chat, and phone availability.

6. Ask good questions
If a patient has trouble following the care plan, ask questions that get at the heart of the problem. Rather than reiterating the desired behavior, try to determine what is causing the difficulty. For example, if a patient hasn’t been taking medication as prescribed, ask questions like these:

  • Do you understand how the medication will help you?
  • What is preventing you from taking the medication?
  • What would help you remember?

Placing the patient at the center of your care means finding ways to help them be successful in their unique circumstances. A combination of education, empathy, and resources to support patients and their family members on a day-to-day basis will ensure the best possible outcomes over the long term.

Starting a Chronic Care Management (CCM) program is a great way to start providing patient-centered care for patients with chronic conditions. With CCM, patients and caregivers have 24/7 access to their comprehensive care plans and monthly check-ins from their care coordinator that address both physical and emotional needs. Plus, CCM increases collaboration between providers, making their care more efficient and beneficial. If you’re interested in starting a CCM program, contact HealthXL® today.