The study by Zafar and Mojtabai examines the impact of various care management processes (CMPs) in the improvement of chronic disease management (CCM) for outpatient care in the US. Zafar acknowledges that CCM is a vital component of primary care management of various chronic diseases including asthma, diabetes, and depression. Zafar and Mojtabai’s study uses data obtained from the 2008 Health Tracking Physician Survey, which provides an ideal sample that covers all physicians in the US. The study evaluates the five components of care management processes (CMPs), which include written instructions on appropriate care in English and other tongues to involve the patients in the administration of their health, the availability of non-medical staff to provide patients with education on managing their condition, the availability of caregivers to assess and organize the care of patients with the condition, and group meetings that involve patients and staff to provide routine medical care and address any patient concerns. The study also sought to find out the proportion of revenue that was provided by Medicare and Medicaid schemes, as well as, the level of adoption of various elements of clinical information technology. The results of the study showed that CMPs were rarely used for the management of depression; however, they were widely used to control other chronic conditions like asthma and diabetes. The use of CMPs was higher in practices that had adopted clinical IT, and those that provided physicians with regular feedback concerning the quality of care. Since the primary objective of Zafar’s study was to identify the adoption of CMPs in the management of depression, it was noted that the adoption of the processes was slower compared to other chronic conditions, though feedback programs and clinical IT could advance its use (Zafar & Mojtabai 2011, p. 638).
The survey was conducted on 4,720 US-based physicians, who were involved in the treatment of patients with diabetes, asthma, and depression (Horvath, Knickman, Colby, S, & M. 2007, p. 11). The responses from the physicians regarding the use of CMPs, as well as, the adoption of IT and compensation through various schemes were analyzed for each of the chronic conditions. The methods used in the study were relevant since the CMPs comprise various methods that are used to empower the patient to take an active role in the treatment of their chronic condition. The findings were useful in determining the involvement of physicians and other caregivers in reducing the prevalence of chronic conditions. The analysis of compensation revealed that Medicare and Medicaid schemes were not primary payers for healthcare. Compensation is a vital component in motivating caregivers to be more involved in the provision of care. The lack of compensation was reflected in the finding that about 40% of the physicians used only one type of CMPs in the treatment of all three illnesses. Less than 4% of the physicians stated that they used all five CMPs, while about 57% claimed to use more than one CMP. The motivation to use more than one CMP can be tied to the number of people who receive more than half of their compensation from either Medicare or Medicare, which accounts for about 25% of the physicians. The adoption of Electronic Medical Records and clinical IT contributed to the higher number of CMPs adopted by physicians. The conclusions obtained from the study are relevant and precise about the prevalence of chronic conditions. The physicians and caregivers are not financially motivated to involve themselves in more than one CMP to meet the diverse requirements for various chronic conditions. This was seen from the low incidents of group meetings as a strategy in the treatment of depression. This is because physicians were not motivated to attend such events and assist in the treatment process.
According to Berardo (2011, p. 1), it is estimated that 133 million Americans suffer from chronic conditions, and the number is expected to increase by over 35% in the next few decades. Berardo further claims that the prevalence has been attributed to the use of traditional methods of managing chronic diseases that involved educating the patients about chronic illnesses to understand their condition and manage it well. Most of these practices are still in use in the CMPs, though there have been adjustments from the traditional chronic care management. The new types of managed care identified by Berardo (2011, p. 3) are more concerned with addressing the problem than the traditional types. These new types provide incentives for physicians to be more involved in the management of chronic disease, as seen in some of the CMPs that involve interaction with physicians in the group meeting, and the involvement of nurse caregivers in organizing the appropriate care for patients (Berardo 2011, p. 5). The paper can lead to the enforcement of various laws and foster programs that fund community-based chronic care initiatives in the fight against chronic conditions in the community.
Berardo, J 2011, The New Face of Chronic Care Management, New York: MagnaCare.
Horvath, A, Knickman, J, Colby, D, S, & M, J 2007, Chronic conditions: making the case for ongoing care, Partnership for Solutions. Baltimore: Johns Hopkins University.
Zafar, W, & Mojtabai, R 2011, Chronic Disease Management for Depression in US Medical Practices, Medical Care, vol. 49, no. 7, pp. 634–640.