Chronic care model

Most chronic illness confronts patients and caregivers with changes in daily life and changes in social relations. They produce disability, often with exacerbations. Medical care is usually continuous and, in the case of the patients with respiratory diseases, is also supported by devices such as oxygen or ventilators (2). Facing the final phases of life is another difficult, added pressure. Most patients with chronic illness require support from a variety of health care professionals, often situated in different health facilities. In the chronic care model, it is crucial to evaluate the patient in a stable situation to establish plans of action for the exacerbations, to promote self-management, and to have a good information system. 

Interim care is defined as frequent care for specified patient populations and close patient monitoring between visits to the primary provider. Interim care models follow a similar process for delivering care as do comprehensive pharmaceutical care models, but on a disease-state specific basis. Many examples of this exist in the CDTM model. Examples of interim-care CDTM models include anticoagulation/heparin clinics and clinics to treat asthma, seizures, pain, hypertension, diabetes, HIV, dyslipidemia, congestive heart failure, and other chronic-disease conditions. 

Unlike the traditional medical device market, most revenue generated from mHealth is not from purchases of fhe apps but rather from the sales of other related services and hardware. Operating under new business models, the apps often serve as platforms to sell the related products. In addition to appearing in online apps stores, more mHealth apps have made their way to traditional health distributive channels. While the first batch of mHealth apps mainly targeted the health and fitness domain, the second generation will focus on chronic care. MHealth apps can generally be divided into the categories listed in Table 6.1. Most of them are native apps instead of web-based applications. 

A glucocorticoid-resistance model has been proposed to provide an explanation for how stress might influence diseases in which excessive inflammation is observed (e.g., allergies, autoimmune diseases, rheumatoid arthritis, and cardiovascular disease). In these cases, chronic stress diminishes the immune system s sensitivity to glucocorticoids that normally terminate the inflammatory response. For example, in a study of a group of 50 parents caring for a child undergoing treatment for pediatric cancer, whole blood of parents of cancer patients exhibited a lesser dexamethasone-dependent suppression of IL-6 production in vitro compared to parents of medically healthy children.94... 

In animal experiments exposures can be carefully controlled, and dose-response curves can be formally estimated. Extrapolating such information to the human situation is often done for regulatory purposes. There are several models for estimating a lifetime cancer risk in humans based on extrapolation from animal data. These models, however, are premised on empirically unverified assumptions that limit their usefulness for quantitative purposes. While quantitative cancer risk assessment is widely used, it is by no means universally accepted. Using different models, one can arrive at estimates of potential cancer incidence in humans that vary by several orders of magnitude for a given level of exposure. Such variations make it rather difficult to place confidence intervals around benefits estimations for regulatory purposes. Furthermore, low dose risk estimation methods have not been developed for chronic health effects other than cancer. The... 

In conclusion, the authors of the cited studies all agree that further research into environmental risk assessment of hospital effluents, incorporating different types of substances used in care and diagnostic activities, as well as cleaning operations (pharmaceuticals, detergents, disinfectants, heavy metals, macropollutants), is vital. Moreover, further studies need to be focussed on evaluating the risk posed by pollutant mixtures, and work is needed to validate the predictive models proposed thus far [19, 49], to evaluate chronic toxicity due to PhCs and then-mixtures and to provide experimental data pertaining to specific case studies. 

Although Rolland s (1994) model is focused on chronic, physical illness, the spirit of his model fits in understanding how families cope with mental illness as well. For example, the demands associated with caring for a family member with a chronic depression are very different from those facing the family of a person who suffers from an acute panic attack, and these are different from the demands created by ADHD. 

At present, pharmacists within the IHS have even more professional authority and latitude to provide patient care. Pharmacists provide primary care for patients beyond treating minor illnesses they can initiate medication orders, and, under medical staff protocols, diagnose, manage, and monitor patients with chronic diseases. The care delivered by pharmacists in this unique setting continues to serve as an exemplary model of the capabilities and impact of the pharmacy profession on direct patient care. 

Mental illness is frequently viewed as an embarrassment or stigma by Asian patients and their families. Asians tend to delay psychiatric care until they are seriously disturbed (Lin et al. 1982). When Asians do enter the mental health system, their psychiatric conditions often have become severe and chronic and likely require psychopharmacotherapy (Lin et al. 1982). Because Asians tend to underuse or avoid seeking psychiatric care, the general public and some health care professionals may believe that Asians are a well-adjusted "model minority" and have little or no need... 

This definition is the same for all models of health systems but the application and focus of care differ. However, in most systems home care implies the application of high technology in the patient s home for a limited period, rather than care for chronic patients. For this reason, in most systems, the referral centers are the hospitals. 

Frei, A., Andersen, S., Hole, P. and Jensen, N.H. (2003) A one year health economic model comparing transdermal fentanyl with sustained-release morphine in the treatment of chronic non-cancer pain . J. Pain Palliat. Care. Pharmacother. 17, 5-26. 

Winkel CA. Modeling of medical and surgical treatment costs of chronic pelvic pain New paradigms for making clinical decisions. Am J Manag Care 1999 5 8276-290. 

Toxic and physiological impacts of polymer stabilizers have been carefully elucidated. Pharmaco-kinetic models for determining the chemical dose delivery to die target tissue were examined and doses responsible for allergies, acute and chronic toxicities were defined [306], Information on potential irritant effects, dermatitis, mutagenicity or carcinogenicity due to amines is of prime importance. It has been estimated that about 75-80% of all human cancers are environmentally induced (30-40% of them by contaminated diet [308]). 

Does the chronic medical condition concept make sense Again, it does for some of the people in our example. Certainly, the disease model examples (Raymond, Fred, Cheryl) appear to have chronic medical conditions. However, Raymond (nausea-treatment alcoholic) did not have any continuing care after treatment, yet he remained sober. Herbert (maintenance drinker) certainly had a chronic problem with alcohol. But, he never had any formal treatment intervention for his drinking and was able to stop drinking and never start again without any assistance. 

Renal Disease is a well recognized complication of gout, and the typical histologic features of chronic gouty nephropathy have been carefully studied, however, early evolution of the nephropathy and its precise relationship to hyperuricemia and uricosuria have been difficult to study in the human subject. Unfortunately, animal models of sustained hyperuricemia are difficult to produce and maintain. Recently, Stavric and colleagues described the production of hyperuricemia and urate nephropathy in rats fed orally with oxonic acid and uric acid, oxonic acid is a potent, hepatic uricase inhibitor and this chemical, combined with uric acid or RNA dietry supplements, consistently leads to hyperuricemia in this species. 

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