Better Control of Chronic Illness

New research suggests ways patients can better control their life-long conditions Landmark survey reveals five steps for success

Research Triangle Park, N.C., – A landmark survey suggests that millions of Americans living with diabetes, asthma, heart disease, depression and other chronic illnesses may gain better control of their illnesses by working with their physicians to implement five specific steps.

“Chronic Care in America™,” a comprehensive survey conducted by Harris Interactive®, is the first to reveal positive behaviors across many chronic conditions, and demonstrate why some people succeed and others struggle to manage a long-term condition. While medical researchers, policy makers and the Bush administration develop strategies to control chronic illnesses and its costs, this new study reveals straightforward actions that patients can take to improve their health today. The actions are based on the behaviors of patients who indicated in the survey that they have succeeded in managing their condition, as well as observations of physicians.

125 million Americans, or more than 44% of the nation’s population, have a chronic condition (1), and many have more than one condition, especially among the Medicare population where 63% have two or more conditions (2). Medical costs for people with chronic diseases account for more than 70% of the $1 trillion spent on healthcare each year in the United States (3).

“While our medical system is well equipped to handle acute conditions, like the flu or ear aches, managing chronic disease is more of a challenge,” says Carolyn Britton, MD, member of the National Medical Association and an advisor on the survey. “The survey shows the impact of the information age and the empowered patient, giving us a fresh look at an old problem. It demonstrates the need for the patient and physician to truly work together to control life-long conditions.” Sponsored by GlaxoSmithKline, the survey identified the five steps that positively influence a patient’s success in managing chronic illness.

Five steps for success

1. Get a “prescription for information”
Information is a form of therapy, helping patients understand, accept and manage their illness. The survey shows that patients who view themselves as being the most successful at living with their condition are more likely to read and learn about their condition than those who are unsuccessful. While they are accessing the abundant health information on the Internet, the survey showed that 86% of patients relied on their doctors for information more than any other source. And both patients and physicians feel the most important physician attribute is the ability to explain things in a way that patients can understand. Patients should ask questions and request information about their condition from their doctor.

2. Be aware of depression
More than just feeling down, depression is a serious barrier to long-term success. Depressed patients are less likely to succeed in managing their condition. Less than half (43%) of those who reported that they had been diagnosed with depression were successful at managing their condition. It is also important to note that those with chronic illnesses have a 25-33% chance of suffering from depression in addition to their other condition(s).  This is a significantly higher risk than found in the general population.

Patients and their caregivers need to be educated about the signs and symptoms of depression and alert the physician when problems arise. Physicians, in turn, can also help their patients by being on the lookout for signs of depression, either as a stand-alone or a co-morbid condition.

3. Make your physician a partner in care
The survey suggests that patients and physicians strike a balance of responsibility, moving toward greater collaboration in the management of illness. Today’s empowered consumer knows there are choices in care and therapy, and while patients look to their physician for information and advice, 55% of successful patients say their physician usually selects treatments with them, not for them.

Kurt Elward, MD, of the American Academy of Family Physicians and member of the advisory board, points to the emergence of a new bedside manner. “Patients want – and need – a more active role in their treatment decisions. They desire a new combination of ‘high tech and high touch,’ as they are guided in the selection and control of their condition. Given new treatment choices, and the many options for medical information, it seems more important than ever to be ‘in the boat’ with the patient as they try to navigate the course of their chronic condition,” says Dr. Elward. “Knowing that many patients see more than one physician, developing relationships with all doctors and helping coordinate care across specialties is also an important point of discussion between patients and their family physician.”

4. Take action immediately after your diagnosis
According to the survey, patients who have successfully managed their chronic condition responded to their diagnosis by swiftly thinking about the lifestyle changes needed and how to adapt to them. Conversely, those patients who were less successful tended to avoid the issue, deny the diagnosis, and withdraw. Specifically, 65% of unsuccessful patients wished their condition “would just go away” at diagnosis and 51% were afraid of becoming a burden. Patients were asked to think back to the diagnosis and talk about what would have been most helpful. The number one answer was learning more about their condition and symptoms earlier. However, an interesting disparity was identified between how much information physicians think they are providing and the amount of information patients believe they are receiving. Few patients said they had received information about websites from physicians, while more than half of the physicians interviewed said that they provided it.

“Diagnosis can be a frightening time for the patient. The patient may not hear or understand everything we have to say,” says Dr. Britton. ”But it is a teachable moment and important time for the doctor to arm patients with information for success, set them off on the right path, and see them soon after diagnosis to ensure they have what they need from the beginning to take charge of their health.”

5. Make a healthy investment in you
Let’s face it, change can be difficult, and most conditions require modifications in diet, exercise, and/or other day-to-day activities. While it is not surprising that successful patients are more likely to have made these types of changes, the question is what enables them to change. Remember, successful patients worked on a plan of action immediately following diagnosis and it’s essential to stick with that plan. There are other steps they took as well.

Successful patients didn’t simply separate themselves from the lives they had before diagnosis. Instead, they often relied on the people and things that had always been a source of strength to help them make constructive changes. Fifty-four percent of respondents said that their family and friends encouraged them to make needed changes in their lives. These patients made a “healthy investment” in time to integrate the management of their condition into a new routine that was both personally motivating and right for their illness. The survey found that physicians recognize their role in helping patients make these lifestyle changes and report their most frequent strategies are providing information, helping patients set goals, and encouraging participation in patient support groups.

“The findings from this survey can help us better manage chronic conditions and improve quality of life,” says Dr. Britton. “It demonstrates that true partnership between physician and patient is key to success, and by working together, we can make huge strides in treating and controlling chronic illness in this country.” To receive copies of a patient brochure on the five steps for success, please call #888-825-5249.

Advisory board

A national advisory board of leaders from organizations working to improve healthcare in America consulted on the survey with GlaxoSmithKline to find day-to-day solutions to the growing health concerns of chronic conditions. Members of the National Advisory Board who aided in design and interpretation of the survey include:

Chronic Care in America™ was conducted by Harris Interactive®, a worldwide market research and consulting firm, and was funded by GlaxoSmithKline. Surveys were conducted within the United States among samples of 3,291 adult patients (ages 18+) and among 1,005 physicians, both by telephone and online between November 11 and December 23, 2002. Figures for age, sex, race, education, income and propensity to be online were weighted where necessary to align them with their actual proportions in the population. In theory, with a probability sample of this size, one can say with 95% certainty that the results have a statistical precision of +/- 2.8 percentage points (for patient data) and +/- 3.1 percentage points (for physician data) of what they would be if the entire population had been polled with complete accuracy.

Gerard Anderson, Ph.D.
Director, Partnership for Solutions
Johns Hopkins University

Richard Bringewatt
President and CEO,
National Chronic Care Consortium

Carolyn Britton, MD,
Finance Chair, Board of Trustees
National Medical Association, and
Associate Professor of Clinical Neurology,
Columbia University

Kurt Elward, MD, MPH, FAAFP
American Academy of Family Physicians

Donald Fisher, Ph.D, CAE
President and CEO,
American Medical Group Association

David Lansky, Ph.D.
President,
FACCT: Foundation for Accountability

Gregg Lehman, Ph.D.
Former President and CEO,
National Business Coalition on Health

Barbara Rimer, Dr.P.H.
Professor, Health Behaviors and
Health Education Deputy Director,
Population Sciences
Lineberger Comprehensive Cancer Center
University of North Carolina at Chapel Hill

Myrl Weinberg, CAE
President, National Health Council

GlaxoSmithKline, with U.S. operations in Philadelphia and Research Triangle Park, N.C., is one of the world’s leading research-based pharmaceutical and health care companies. GlaxoSmithKline is committed to improving the quality of human life by enabling people to do more, feel better and live longer.

References

1. Partnership for Solutions, The Problem: About Chronic Conditions, July 2002.

2. The Center for Medicare Advocacy, Inc., The Clinical Characteristics of Medicare Beneficiaries and the Implications for Medicare Reform, March 2002

3. Centers for Disease Control and Prevention, Unrealized Prevention Opportunities: Reducing the Health and Economic Burden of Chronic Disease, November 2000.