In this ground-breaking new work, Patrick J McEvoy connects with healthcare professionals, patients and illness to presenting an entirely new way to address chronic disease management. By reflecting on the very nature of chronic disease, rather than focusing on its consequences, the book sheds new light on the complex realities of general practice, explaining the intricacies of community medicine, and its relationship with both sociology and epidemiology. Highly practical in its approach, the book offers a generic paradigm of chronic disease, a trajectory-based model of clinical management and a curriculum for chronic care. It provides thought-provoking reading for all health and social care students and professionals, post-graduate trainees in General Practice and their trainers seeking inspirational new ways to manage chronic disease.
Foreword. Introduction: Chronic disease, its natural history and ecology. Chronic disease; what's so special about it? Overview: the executive summary. Chronic disease management in a nutshell. Are you interested in chronic disease? How many chronic diseases have you? Scenario: A consultation. The impact of chronic disease. Some characteristics of chronic disease: trajectory, psychosocial and system constructs. Disability as a chronic condition. Scenario: Tutorial time. References. The story of chronic disease. Overview of chapter two. Scenario: Story time. Chronic disease, the enemy within. Profiling chronic disease: chronic-v-acute disease. Models of disease. Comorbidity and multimorbidity. The natural history of chronic disease - the life-cycle of the dragon. The ecology of the dragon. Entering the dragon's den. Laying the foundation stone of the chronic disease paradigm. Summary: the story to date. A bit of epidemiology. References. The journey through chronic disease. Overview of chapter three. What is it like to live with chronic illness? Scenario: A case study. The patient's journey through chronic disease. The early days; the importance of diagnosis. The middle passage; illness progression and transitions. Advanced disease; the palliative phase and end of life. The clinician's journey with the patient. Time as the measure of chronic illness. What patients want. The sociology of health and disease. The sick role - the person and illness behaviour. The healer role. Disability and handicap. The social determinants of health and disease. Scenario: A reflective learning diary. References. Care of the chronic sick - the community complex. Overview of chapter four. Who cares? Scenario: The village. Care in the community. Levels of care - why, how much, where and at what cost? Issues in care: Autonomy, advocacy and agency. The expert patient and self-management. Personal and public involvement. The caring professions. A historical note on the UK systems of health and social care. Scenario: A proposed practice policy on carers. Conclusion and reflection. References. The clinical complex: the General Practitioner and chronic care. Overview of chapter five. Part one: General Practice as the focus of chronic disease management. What GPs do - fishing or filtering? General practice - concept and method. Defining general practice. The primary care team and multidisciplinary teamwork. Designated clinics in General Practice. The GP-hospital interface. A primary care paradigm shift. Health promotion and health education. Scenario: A review of progress. Part two: Developing the clinical complex. Electronic media and GP/FM. Internet interventions and self-help. Integrated care. Commissioning chronic care. The quality agenda. Patient involvement and quality. Clinical effectiveness. Outcomes. Management and governance. Evidence, guidelines and audit. Conclusion and reflections. References. A chronic care revolution - service re-design and the policy complex. Overview of chapter six. Health policy: global, national and local. Who policy and chronic disease management. Unpacking health policy. Building blocks of the chronic care revolution. Scenario: A coffee break. Ten characteristics of an effective health service and four strategies. Social policy and chronic care. A 12-step rehabilitation programme. Summary. References. The learning and teaching complex through the chronic disease paradigm. Overview of chapter seven. Medical education in primary care - a UK profile. How is chronic care taught? The chronic disease paradigm. The chronic disease paradigm unpacked. The patient complex. The clinical complex. The community complex. The policy complex. The disease complex. The learning and teaching complex. Chronic illness care for students and trainees. Chronic illness care - a new specialism. A curriculum for chronic illness care. Scenario: Reflections of a trainer. Scenario: Learning through chronic disease. Summary and reflection. References. Meeting the challenges of chronic care. Overview of chapter eight. We have a problem on our hands! The NHS is well placed. General practice meeting the challenge of chronic disease? A menu of tactical responses. Taking stock of UK primary care. Slimming practice and noise abatement. Chronic care guidelines for the GP. Conclusion. References. Appendices.