Managing Your Chronic Disease

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Chronic diseases such as asthma, heart disease, arthritis, and diabetes currently affect more than half of all American adults, with two out of three patients having multiple conditions. The incidence of these conditions is expected to increase, as members of the baby boom generation reach the ages when such diseases become more prevalent.

Traditional care for these chronic conditions has centered on the physician’s role, but a new model of care is emerging - one focusing on patient self-management.

The November edition of Physician Focus with the Massachusetts Medical Society examines these kinds of programs with two members from The Healthy Living Center of Excellence, a collaborative program of Elder Services of the Merrimack Valley in Lawrence, Mass. and Hebrew SeniorLife in Boston.

Robert Schreiber, M.D., Medical Director, and Jennifer Raymond, J.D., M.B.A., Director of Evidence-Based Programs, join host B. Dale Magee, M.D., a past president of the Massachusetts Medical Society, to discuss the purpose, goals, and benefits of this new model of care.

Through regional-based efforts with community organizations, health care providers, health plans, government, and foundations, the Center offers free programs in community-based settings from seven regional centers throughout Massachusetts that help patients 18 years of age and older with chronic conditions manage their own care.

Dr. Schreiber describes the new model as one where “the patient is the captain of his or her health care ship” and the clinician is there to offer help and guidance when needed.

“One of the key issues that we see,” says Dr. Schreiber, “is that individuals who have a condition are told what they need to do, but they have to modify their lifestyle significantly to incorporate that change, and they need help in understanding what they need to do on a day-to-day basis to actually implement that change.”

The Center’s programs are customized to the particular needs of the patient and go beyond the traditional medical care of physical testing and evaluation, taking into account the many factors that influence health – including behavioral, environmental, and lifestyle issues - to build support systems for the patient.

“The programs are not designed to replace the physician,” Ms. Raymond is quick to point out, but rather to establish a “partnership between the physician and patient.”

I invite you to join us this month on Physician Focus to learn about a new approach to managing chronic disease that for many patients has led to better health outcomes, better care experiences, and better communication with their health care providers.

Patients and providers may call The Healthy Living Center of Excellence at 1-800-892-0890 for more information or to enroll in any of the programs offered through seven regional centers in Massachusetts.

Photo, left to right: B. Dale Magee, M.D., Jennifer Raymond, J.D., M.B.A.,; Robert Schreiber, M.D.