Managing Chronic Disease in the Primary Care Setting

Introduction

The increasing prevalence of chronic disease in the US has diverse implications for healthcare policy-makers, providers, and practitioners. As a result, it is imperative to have an understanding of its effect on the healthcare system, ways of curbing the rising costs associated with chronic diseases using evidence-based treatment, and implications for the roles of nurses, which comprise the focus of this paper.

Impact of Chronic Diseases on Healthcare

The prevalence of chronic diseases is the highest in the US and constitutes the most expensive health care problems. About 45% of the US population (about 133 million) suffer from at least one chronic condition. In addition, at least 66% of deaths in the US have been attributed to at least one of the five chronic conditions including diabetes, obstructive pulmonary disease, stroke, cancer, and heart disease (Ward & Schillaer, 2013). A continuation of the current trends will imply that 20% of children being born will be diabetic at some point in the course of their lives (Ward & Schillaer, 2013). Majority of the chronic diseases span the lifetime of an individual. They do not only lower the quality of life for an individual having a disease, but also for their caregivers and family members. Chronic conditions tend to limit the activities of a patient as well as those around them.

The impact of chronic disease extends beyond just the quality of life and health of people to increase the healthcare costs and reduce the affordability of care. Estimates show that 75% of the US aggregate healthcare expenditure goes to chronic disease, which translates to about $5,300 per person (Ward & Schillaer, 2013). For the case of tax-payer finance programs, the treatment of chronic conditions account to an even higher percentage of healthcare expenditure – 86% the case of Medicaid and 96% for the case of Medicare. According to statistics, an average Medicare patient suffering from a single chronic conditions visits four doctors whereas those having at least four chronic disease visit 14 different doctors annually (Donnelly, Paggetti, Nugent, & Mokhtari, 2012). Disease-specific estimates show that cardiovascular disease costs about $147 billion yearly, costs associated with diabetes reach about $174 billion yearly, obesity costs are about $147 billion, whereas the healthcare costs of lung disease are estimated to be $147 billion yearly. Furthermore, the population of those aged 85 years and above is forecasted to increase to about 21 million as of 2050, which will lead to a significant increase in the proportion of very-high-cost patients in the US (Donnelly et al., 2012). In addition, bulk of the sustained increased in healthcare expenditure documented in the course of the 20 years can be attributed to the increase in the prevalence and new technological innovations that seek to treat chronic conditions. The increasing incidence of chronic disease also threatens the affordability of healthcare coverage. From 2,000 onwards, there has been a consistent increase in the health insurance premiums for family coverage sponsored by employers (Donnelly et al., 2012). For people with chronic conditions, the average healthcare costs is $6,032 per year, which is five times higher when compared to those without any chronic condition (Donnelly et al., 2012). In general, the impact of chronic diseases on healthcare include reducing the quality of care for those suffering from such conditions and those around them, increasing healthcare costs, and threatening the affordability of healthcare.

Using Evidence-based Care Plans to Reduce Healthcare Cost Burden and Its Cost Effectiveness

The costs of healthcare are rising to unsustainable levels; nevertheless, there is an untapped potential to curb the increasing costs and deliver better health outcomes through better and targeted treatments. In theory, evidence will increase the confidence regarding what treatment works for each patient interacting with the healthcare system, which is a perquisite for high quality care that draws upon solid evidence (Kolodziej, 2011). Amidst the increasing costs of healthcare, the development of evidence-based treatment plans will be crucial in achieving personalized treatments that are effectively targeted to lower costs. Fundamentally, better evidence such as longitudinal and comparative data is required to ensure the usefulness as well as the effectiveness of new treatments and clinical interventions. This is based on the presumption that evidence-based treatment is targeted and effective, which means that additional costs associated with ineffective treatments are eliminated (Kolodziej, 2011). Many literature sources state that using standardized models of care do not enhance the quality of care but also lessens healthcare costs and increases the predictability of costs. In general, developing specific clinical interventions for targeted populations has the potential of eliminating wastes in the healthcare system attributed to ineffective treatments that are yet to be proven.

Evidence-based treatment offers vast opportunities for reducing healthcare costs including using less costly drugs, reducing overall therapy, decreasing costly supportive care drugs, and reducing the number of hospital visits. Drugs for treating chronic conditions are often expensive; as a result, finding ways to reduce the costs of drugs can significantly lessen healthcare costs (Kolodziej, 2011). Evidence-based treatments can lessen care costs through the optimal use of less costly drugs. Empirical evidence supports numerous less expensive therapies that deliver same quality as costly therapies. With evidence, a significant reduction in therapy can be documented, which in turn lowers cost. This is because when treatment guidelines are supported by evidence, doctors can confidently recommend the most effective intervention as the first line treatment. An effective first-line treatment eliminates the need for subsequent second and third line treatment. Evidence-based treatment can reduce the number of hospitalizations attributed to complications and adverse effectives, which, consequently, lowers the cost of treatment. With respect to the cost effectiveness of evidence-based treatment, various studies have affirmed that evidence-based guidelines are cost effective (Kolodziej, 2011). For instance, Neubauer et al. (2010) performed a research that sought to assess the cost effectiveness of evidence-based care for patients having non-small-cell lung cancer. The results of the study showed that evidence-based first line treatment reported significantly lower costs by 35% when compared to second-line treatment over a period of twelve months.

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