Chronic conditions need continual care

According to the Centers for Disease Control, chronic diseases have become the leading cause of death and disability in the United States, account for 7 out of every 10 deaths and affect the quality of life of 90 million Americans. In 2002, direct medical costs reached $92 billion and indirect costs (including disability, work loss and premature mortality) totaled $40 billion. Perhaps the most confounding fact is that although chronic diseases are among the most common and costly health problems, they also are among the most preventable.

Healthcare providers struggle daily with patients who simply cannot cope with the reality of their condition, manage their medications properly, adapt their diets appropriately, or worse, refuse to. Given an average physician visit often lasts less than 20 minutes, healthcare providers are constrained in what support or advice they can provide to combat the psychological and emotional barriers to chronic disease management. A patient newly diagnosed with a chronic disease such as diabetes, is likely experiencing a combination of confusion, guilt, worry and resentment.

Many certified diabetes educators (CDEs) say these thoughts and feelings often manifest patient resistance to lifestyle changes such as losing weight and quitting smoking, as well as vital medical interventions such as daily blood glucose testing or blood pressure monitoring. These individuals are isolated and overwhelmed by their conditions. As a result, they feel highly victimized by diabetes, and may either completely ignore the information, advice and recommendations of their healthcare provider or only half-heartedly follow their instructions.

With nearly 21 million Americans living with diabetes and another 41 million believed to be pre-diabetic, this chronic disease has reached epidemic proportions. Yet about two-thirds of people diagnosed with diabetes are knowingly not doing enough to treat it.

To affect the diabetes epidemic and other major chronic diseases, the entire healthcare industry-professionals (including specialists and educators), payers (including specialists and educators), and the patients' network (their family and friends)-must work together to overcome the emotional and psychological issues that prevent appropriate treatment. Ignoring these thoughts and feelings or worse, becoming frustrated or incapacitated by them, will only tax the healthcare system, the government and society at large.

In addition to the patient's inner struggles to accept their condition, demographics can limit patients from seeking treatment or properly managing their disease. Research demonstrates that women are typically more active participants in their healthcare then their male counterparts. Language barriers pose obvious hurdles, but simple translations are not entirely the answer. Basic literacy and comprehension are paramount to following often complex and sometimes conflicting advice from physicians and specialists. Add dementia and other cognitive ailments and the problem compounds.