The Role of Home Care In Treating Chronic Disease
March 29, 2013
The Role of Home Care In Treating Chronic Disease
Trends in data demonstrating that the cost of health care in the US has been growing at a staggering pace, have forced researchers and clinicians to develop ways to enable them to practice more efficiently and effectively. Hospitals are looking to partner with providers, and home health agencies that understand the importance of reducing hospital re-admissions, as repeated admissions will directly impact their reimbursement. America is bracing itself for the future of healthcare, as there are so many uncertainties as to how we will be able to afford the delivery of healthcare as we know it today. Public funds are paying for a large share of healthcare costs through Medicaid and Medicare, as well as other programs. Available data identifies chronic disease such as heart disease, diabetes, and stroke, respiratory diseases, as major sources of illness, hospitalizations, and long term disability in the US. It has become apparent that the answer to this dilemma does not seem to lie within any of the systems that we currently have in place. There seems to be a call for innovation, and simply put “thinking outside the box”. Aggressive interventions are now needed to prevent complications of chronic disease and reduce their cost, as they are expected to continue to worsen in the future. To put things into proper perspective, let us examine some statistics which were reported by Lisa Yarkony, in her article entitled” The War on Chronic Disease: How Can We Turn Back the Tide ”( 2013, p. 13)
- More than 25 percent of Americans now have two or more chronic conditions that require ongoing medical care and make it hard for them to have independent lives
- Two thirds of Americans over 65 and three-fourths of those over 80 have multiple chronic diseases, and 69 percent of Medicare dollars go to people with five or more chronic conditions.
- By 2020, the number of people with multiple chronic conditions is expected to be 81 million, up from 57 million in 2000.
- By 2020, the number of people over 85 will likely reach 6.6 million, up from 5.5 million in 2010.
- The health care system suffers too, since the medical costs of people with chronic illnesses represent 75 percent of the $2 trillion in U.S. annual health care spending. In addition, the costs both personal and financial have led to a call for public action.
In one Research study, conducted by the Healthy States task force, strategies were identified that focused on six areas: preventing or reducing tobacco use, increasing physical activity & improving nutrition, preventing heart disease & stroke, control of diabetes, prevention of cancer through screenings, and improving oral health ("Healthystatescsg.org," 2006.)
With the rising cost of health care, especially attributed to hospitalization and long term care placement, it is logical to assume that home health care will play an integral role in providing a solution to the complex problem of chronic disease management. Educating patients regarding self management skills for chronic disease will need to be the focus of providers, in order to reduce hospital re-admissions, and in effect reduce cost. Home care nurses, physical therapists, and other disciplines are in a prime position to initiate and evaluate teaching of their patients. Agencies that utilize Telehealth are positioning themselves to be “chosen” team members of hospital driven quality improvement initiatives. Many patients report increased satisfaction with home care because they feel like they are still being monitored in between nursing visits with Telehealth. The system provides the agency with BP readings, weights, and other data, which is communicated to a central monitoring station for evaluation by a nurse.
According to John Patton, “In a 2011 AARP study, over 80 percent of seniors reported that being able to stay in their home as they age is extremely important to them. He also points out that living with chronic disease can interfere with that goal and living with multiple chronic diseases can complicate it exponentially. It is predicted that in the future, patients will be allotted a sum of money to manage their health care and be given the opportunity to choose how to spend it. For example, they can choose to stay at home in the care of nurses, or they may choose to go to long-term care facilities. Given the proper guidance, this concept affords the patient many advantages. In some Medical Models, the state will even pay family members to stay home to care for a family member, since they may be unable to work and care for their loved ones. Fostering care in a happier environment for seniors in a cost effective manner makes a lot of sense. The provision of home health fits rather well in this cost saving plan, aimed at improving patient care outcomes, and patient satisfaction simultaneously.
The solution does not stop here however, as we are all challenged to come up with new and innovative ways to improve health care. We must all think outside of the box. Even providers are wise to develop or become trained in innovative techniques, in order to provide skilled care with the goal of reducing complications of chronic disease. Here are a few examples of such strides made by providers in our very own community:
Dr. Kamlesh Pandya is now able to offer a new treatment for severe asthma that is not well controlled by conventional means, such as with high dose inhaled corticosteroids and long–acting bronchodilator therapy. Dr. Pandya is a pulmonologist and is Board certified in Internal, Pulmonary, Critical Care, and Sleep Medicine. He received his medical degree from Surat Municipal Institute of Medical Education and Research in India. Recently he received additional training on performing Bronchial Thermoplasty, which involves the application of radiofrequency energy to the airways distal to the main-stem bronchi down to airways, which are as small as 3 mm in diameter. Treatments are done in three separate sessions, each lasting up to an hour, during which the smooth muscle layer is ablated from the airway using radioactive frequency. Benefits of the procedure include improved asthma symptoms, quality of life, and less health care utilization for patients with difficult to control asthma. This is significant because asthma is a chronic disease that affects people of all ages, which can impede the lifestyles of individuals when their symptoms are not well controlled.
One area cardiologist, Dr. Amy Eversole, who received her medical degree from the University of Cincinnati College of Medicine in Ohio and is Board certified in Internal Medicine and Cardiology with additional training in Nuclear Cardiology, specializes in preventive cardiac medicine by using high tech imaging studies such as nuclear stress testing and MUGA scans to diagnose coronary artery disease. Dr. Eversole explains, "Nuclear testing provides a non-invasive means to diagnose and monitor disease which allows aggressive control of risk factors. These exams are particularly useful in detecting significant heart disease before it progresses to an infarct (heart damage) especially in diabetic patients and patients who have asymptomatic disease. Adequate control of risk factors such as hypertension, obesity, diabetes, and hyperlipidemia (high cholesterol) can greatly reduce the progression of coronary artery disease." Dr. Eversole, an avid runner, states, "I encourage my patients to include exercise as part of their treatment because of the beneficial effects that it has on controlling risk factors". She further reports, "The only risk factor that you can not control is a family history of heart disease".
We consulted an area Neurologist, Dr. Linda Pao, who is a Board Certified Neurologist, for her expertise on Cerebral Vascular Accidents (CVA’s), better known as a stroke. Dr. Pao attended Brown University/Alpert Medical School. She currently practices at the Cleveland Clinic located in Palm Beach Gardens. According to her, the best treatment for stroke is prevention. She states, “Therapies to prevent a first or recurrent stroke are based on treating an individual’s underlying risk factors for stroke, such as high blood pressure, atrial fibrillation, and diabetes”. She explains, “Treatment will depend on the type of stroke an individual is having. If the stroke is ischemic, the goal will be to dissolve the blood clot. If the stroke is hemorrhagic, however, treatment will be aimed at stopping the bleeding. Stroke risk is greater if a parent, grandparent, or sibling has had a stroke. Individuals can reduce their risk by adapting health lifestyles, such as maintaining a healthy weight, eating healthy, exercising and by avoiding smoking.” If you have any additional questions for these experts you may contact them at their offices, as listed below:
Dr. Kamlesh Pandya
(772) 807-6500
Dr Amy Eversole
(772) 286-9400
Dr Linda Pao
(877) 463-2010
References
Patton, J. W. (2013). Prevention is the name of the game when it comes to chronic disease. Caring, 32, 21-23.
Primary care physicians and health coach teams improve outcomes and reduce costs for complex patients. (2007). Retrieved from http://innovations.ahrq.gov/content.aspx?id=2941
Using sound science to prevent chronic disease: state policy implications. (2006). Retrieved from http://www.healthystates.csg.org/NR/rdonlyres/CCA2258C-F4A5-41DE-9B26-0D22A09CD228/0/TAUsingSoundSciencetoPreventChronicDisease.pdf
Yarkony, L. (2013). The war on chronic disease: how can we turn back the tide. Caring, 32, 13-15.
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