Discussion Session: Chronic Disease Care
Dr. Lapointe, an academician whose research interests include resistance to information technology and the implementation of information systems in the healthcare industry, moderated the discussion between Dr. Kane and Dr. Butler-Jones.
Both presenters had considered chronic disease’s role in healthcare resource utilization, and the burden of chronic disease on patients themselves and the society at large. Dr. Lapointe noted that three uniting concerns bridged the speakers’ presentations. They both discussed the extent to which aging is properly seen as a challenge; both addressed which health and policy achievements qualified as indices of success (e.g., cure versus care, how to best assess outcomes, and the best provision of resources); and, finally, both considered how health professionals in clinical care and those that work with governments can ensure improvements in managing aging and chronic disease on a systemic level, highlighting the role of information technology in the process.
Dr. Kane was queried on the value of making changes at the level of medical training to better meet the challenges of frailty, disability, and dependency among aging adults. Dr. Kane offered doubt that medical schools represented the best site of intervention due to several factors. Training methods and content tend to be conservative and challenging to alter. Further, given the delay between instituting philosophical and practical change and when effects manifest, change may be excessively belated and the information possibly anachronistic. Finally, trainees may enter the clinical context with the correct knowledge, but the environments in which they work may be inhospitable to change.
Dr. Butler-Jones concurred, adding that there is no single site at which to make the changes necessary to better deal with the increasing chronic disease burden. He added that interventions should not ignore the medical schools, however, given increasing interdisciplinarity among healthcare professionals, as well as the mobility and dynamism between academic, clinical, and policy contexts. These represent multiple target points for new research findings.
Another issue raised was that of the Baby Boomer generation and the effect their entry into the ranks of seniors will have. Does the size of the demographic mean that they are bound to reshape health policy? Dr. Butler-Jones affirmed the notion, noting that the generation has altered society at every stage of life. Dr. Kane in turn challenged the suggestion, noting that the greatest changes they stand to institute come in the form of their advocacy for their parents’ generation. Once they themselves become infirm, their capacity to serve as radical advocates for themselves or for wider change within the healthcare system will be compromised.
Dr. Kane was given the opportunity to elaborate several of his ideas on optimizing healthcare delivery in an environment of burgeoning chronic disease prevalence. He had advocated eliminating regularly scheduled follow-up consultations in favour of primary care utilization based on change in health status. Rather than seeing this as a reduction in follow-up visits, Dr. Kane described the practice as one that facilitates systemic tracking of chronic illness.
Dr. Butler-Jones agreed that this revised approach to follow-up care could enhance monitoring. Other forms of patient tracking outside of regularly scheduled follow-up appointments could improve patient health behaviours, he stated, citing study data finding that weekly/bi-weekly calls from a nurse reduced subsequent emergency room visits, and improved treatment adherence.
Dr. Kane was challenged on his suggestion that team-based care leads to inefficiencies and fails to alter outcomes. Dr. Kane advised that team approaches can experience success when team participants have well-defined roles and adhere to them, and function with trust of their partners. Research and clinical experience has shown that collaborative care can instead be duplicative and an inefficient use of time.
As up to one-third of current health professionals are nearing retirement age, panelists were asked to consider the severity of shortages in primary care availability and how patients’ access to primary care practitioners might be assured.
Dr. Kane responded that if the importance of primary care is not affirmed institutionally, governmentally, and societally, the crisis in care availability will worsen. Remuneration must be improved, and costs must be recouped in the context of an economic model that accounts for reduced hospitalization and crisis visits. The sustainability of the healthcare system depends on the society’s ability to meet the challenge of chronic disease, and investments must occur in primary care rather than large hospitals.
Dr. Butler-Jones hoped that more effort would occur on the level of training to encourage practitioners to enter the field, rather than continuing to foster a sense of elitism and upholding the specialist as the model practitioner.