Chronic Disease Management
Disease management means taking actions to ensure the best possible level of health and functioning for the individual and the least amount of disruption of daily life. Implicit in the concept of chronic disease is the idea that no cure for the given illness is available and the condition must be managed to reduce its impact on the patient, family, and society.
Management strategies comprise an individual's means to keep the disease and its effects under control (Clark, 1998; Karoly & Kanfer, 1982). These strategies may be effective or ineffective and may be consistent with clinicians' recommendations or not. Some people left to themselves will derive ways to achieve disease control that physicians or health educators would applaud (e.g., a susceptible asthma patient removing environmental precipitants to symptoms from the living quarters). Many do not (e.g., the person with asthma overusing bronchodilators in an effort to reduce symptoms).
Effective disease control requires a strong partnership between patient, family, and clinician and adequate support from the health system and community to the individual who must manage the condition from day to day. Disease management is undertaken in full recognition that actions will not eliminate the disease but reduce its impact, for example, prolong life, enhance functioning, and in some instances reduce costs.
Similar themes run across definitions of chronic disease management by the patient (Creer, Levstek, & Reynolds, 1998; Karoly & Kanfer, 1982). First, 90% to 98% of day-to-day management is carried out by the patient. Second, recommended regimens involve a changing and complex set of behaviors and are not allor-none phenomena (Glasgow & Eakin, 1998). Third, the context (setting and conditions) in which one manages influences the strategies utilized (Creer et al., 1998). Fourth, effective management by the patient requires a shift from well-established, habitual...