(Last Updated On: August 30, 2017)

Two out of every three older Americans have multiple chronic conditions, and treatment for this population accounts for sixty-six percent of the country’s health care budget (1).  About three-quarters of adults 40 and older with a chronic condition admit to at least one non-adherent behavior in the past 12 months, and more than half report multiple forms of noncompliance (2). Heart disease and cancer pose their greatest risks as people age, as do other chronic diseases and conditions, such as stroke, chronic lower respiratory diseases, Alzheimer’s disease, and diabetes (1). Patients with limited mobility and independent professionals will benefit from the support services provided by Chronic Care Management. CCM coordinators providing support services are essential for these patients to maintain appointment compliance and health literacy.

CCM Improves Appointment Compliance

Quality healthcare outcomes depend upon patients’ adherence to recommended prevention and treatment regimens (3). More than forty percent of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice (3). It is imperative that coordinators assist patients with maintaining compliance to follow-ups, annuals, and specialty provider appointments. Appointments may be used to assess and/or help manage the following health concerns or conditions, such as:

Considering the listed chronic conditions and risk factors, Chronic Care Management patients should not only receive continuous education, but help with all tasks related to their appointments. Chronic Care Management patients should receive assistance from their coordinator with the following:

  • Scheduling multiple provider appointments
  • Coordinating health maintenance screenings (e.g. mammograms, colonoscopy exams, bone density scans)
  • Maintaining compliance to treatments and medications
  • Accessing and/or arranging transportation options

Coordinators should be a support to ensure that each CCM participant is able to maintain his or her health daily. Discussion of changes in daily activities, medication reconciliation, and communication of any concerns with the provider are critical benefits of appointment compliance promoted by CCM coordinators. CCM patients should experience increased independence and well-informed care.

CCM Promotes Health Literacy

As a requirement of Chronic Care Management, coordinators are available to patients 24/7. CCM patients should experience the benefit of having a direct person of contact for questions in between doctors’ appointments, notifications of new symptoms, and concerns of medications. Low health literacy often leads to poor self-management by chronically ill patients. For example:

  • Only twelve percent of adults have proficient health literacy, according to the National Assessment of Adult Literacy
  • Nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease(4).
  • Approximately, fourteen percent of adults (30 million people) have below basic health literacy(4).

Not only are patients participating in CCM provided with personalized education for their current chronic conditions, but they also receive tips for preventing additional chronic conditions. For example, below are sample questions that should be covered by CCM coordinator with a patient with hypertension:

  • What is hypertension?
  • Which medication is for my high blood pressure?
  • Are there any signs or symptoms I should watch for?
  • Where do I get a blood pressure monitor?
  • How do I check my blood pressure?
  • What is a normal blood pressure result?
  • When should I follow up with my doctor?
  • Am I eating the right foods?
  • How can I improve my blood pressure and/or symptoms?

For patients to implement the best self-management methods, questions such as the above and other concerns should be tackled by coordinators. Caregivers, families, and patients participating in Chronic Care Management will notice less stress from managing chronic conditions. By improving health literacy, CCM patients should have enhanced quality of care and compliance to provider instructions.

References
  1. The State of Aging and Health in America . s.l. : Centers for Disease Control and Prevention, 2013.
  2. Medication Adherence in America. [Online] National Community Pharmacist Association. [Cited: November 22, 2016.] http://www.ncpa.co/adherence/AdherenceReportCard_Full.pdf.
  3. US National Library of Medicine. [Online] National Center for Biotechnology Information, U.S. National Library of Medicine. [Cited: November 22, 2016.] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/.
  4. U.S. Department of Health and Human Services. [Online] Office of Disease Prevention and Health Promotion. [Cited: November 22, 2016.] https://health.gov/communication/literacy/quickguide/factsbasic.htm.