Advantages and Limitations ofDisease Management:A Practical Guide

摘要

Disease management and population based programs have most often yielded disappointing results, in both measures of effectiveness as well as efficiency. Seldom have these resulted in cost savings. Too often programs have parachuted a modicum of disease and population management into an otherwise traditional setting, and not surprisingly results have been elusive at best, and negative at the worst. Most programs have been medically oriented, and although the medical aspects have been sound, they lack sufficiently extensive behavioral interventions that are both highly targeted and focused, as well as being empirically derived. It is now an accepted fact that between 60% and 70% of physician visits are by patients who are manifesting a translation of stress into physical symptoms, or whose physical disease is being complicated by psychological factors, and which very often result in non-compliance with medical regimen ( Follette & Cummings, 1967; Cummings, Cummings & Johnson, 1997; Karon, VonKorfT, Lin, Lipscomb, Russo, Wagner & Polk, 1990; Kroenke & Mangelsdorff, 1989).