Editor's choice

Managing chronic disease

This article originally appeared in BMJ USA

The Institute of Medicine's report on Crossing the Quality Chasm, released in March of this year, pointed out that "chronic conditions are now the leading cause of illness, disability, and death in the United States, affecting almost half of the population and accounting for the majority of health care resources used." The IOM recommended that key stakeholders in health care develop strategies, goals, and action plans to achieve substantial improvements in quality for 15 priority conditions. The BMJ has been a leader in moving this agenda forward. With support from the Robert Wood Johnson Foundation, the BMJ has published two theme issues on chronic disease management, including its October 27, 2001 issue (available on bmj.com). Several items in this issue of BMJ USA deal with chronic illness.

Epping-Jordan and her colleagues from the World Health Organization, in an editorial from the BMJ 's theme issue on managing chronic disease, point out that health care professionals can do more to engage patients in managing their own conditions and in using treatments properly (BMJ USA p 570). But in their harried practices, physicians may need help in educating patients about self-care and treatment compliance. More and more that assistance is coming from disease management programs administered by health plans, medical group practices, or specialized commercial firms. In a systematic review of 12 randomized trials of multidisciplinary disease management programs for patients with coronary heart disease, McAlister et al found that these programs improve processes of care, reduce hospital admissions, and enhance quality of life or functional status (BMJ USA p 575).

Asthma is one of the most common chronic conditions seen by primary care physicians. On BMJ USA p 603, Cates reviews the evidence regarding benefits and risks of treatments for chronic asthma. For many chronic conditionssuch as musculoskeletal pain, urinary incontinence, stroke, and respiratory diseasephysiotherapy is an important component of treatment and rehabilitation. Herbert et al provide an update on the efficacy of physiotherapy in light of recent clinical trials (BMJ USA p 595).

In a touching story, Sutherland describes a patient with COPD who shared his prednisone with his wheezing dog (BMJ USA p 581). The dog's wheeze improved dramatically, but when the patient's respiratory educator explained that the treatment might kill the pet, the patient replied that quality of life was more important than quantity.

Finally, we continue our coverage of September 11 and its aftermath, with editorials and articles about the psychological implications of chemical and biological weapons (BMJ USA p 566), treatment of anthrax (BMJ USA p 568), research on the anthrax toxin (BMJ USA p 617), the need for physicians to speak out on war and humanitarian crises (BMJ USA p 617), and medicine's response to the attacks on 9/11 (BMJ USA p 619).

Epping-Jordan et al (BMJ USA p 570) http://bmj.com/cgi/content/full/323/7319/947

McAlister et al (BMJ USA p 575) http://bmj.com/cgi/content/full/323/7319/957

Cates (BMJ USA p 603) http://bmj.com/cgi/content/full/323/7319/976

Herbert et al (BMJ USA p 595) http://bmj.com/cgi/content/full/323/7316/788

Sutherland (BMJ USA p 581) http://bmj.com/cgi/content/full/323/7307/270

Wessely et al (BMJ USA p 566) http://bmj.com/cgi/content/full/323/7318/878

Hart & Beeching (BMJ USA p 568) http://bmj.com/cgi/content/full/323/7320/1017

Gottlieb (BMJ USA p 617) http://bmj.com/cgi/content/full/323/7320/1022/a

Eaton (BMJ USA p 617) http://bmj.com/cgi/content/full/323/7316/771/c

Davis (BMJ USA p 619) http://bmj.com/cgi/content/full/323/7314/700