Chronic Disease Management: A New Paradigm for Care

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 an