Transcript Chronic Disease Management

Chronic Disease
Management
Beyond CDM Payments
Dr Bruce Davies
Scope
What common diseases?
Should they be formally managed?
Frequency
Importance
Follow up affects outcome
Know what to do
Where is follow-up most appropriate?
Brainstorm
What conditions are
important under
these criteria?
Perhaps
Diabetes
Asthma
COPD
Hypertension
? Epilepsy
High risk drug users ie DMARDs etc
Contraception
CDM Payments
Asthma
Diabetes
Small fee per GP per
year
Criteria to claim
Requirement for
audit
Ways and Means
Opportunistic
Dedicated clinics
Nurse led clinics
Specific appointments
Disease registers
Protocols
Guidelines
Better Care or Just PC
Sometimes hard to
tell!
Evidence for
effectiveness?
Need for audit
More work
More treatment
More iatrogenic
problems?
Polyclinic Model of Care
The list of things can grow and grow.
Advantages.
Disadvantages.
Professional satisfaction.
Quality.
Fragmentation.
Fall between two stools.
Generalist Model
Copes with everything.
Advantages.
Disadvantages.
Professional satisfaction.
Holistic.
Failure to care systematically.
Registers
Creation.
Maintenance.
Accuracy.
Usage.
Whose responsible?
Manual viz.
Computer.
Protocols
Authority.
Ownership.
Access.
Who follows.
Benefits.
Disadvantages.
GOBSAT viz. EBM.
Records
Whose responsible?
Paper or computer?
Accuracy.
Meaning.
Why poor?
Audit
PC or use?
Who does?
More work for what
value?
Do people change
as a result?