慢性疾病管理.pptVIP

Chronic Disease Management Beyond CDM Payments Dr Bruce Davies Scope What common diseases? Should they be formally managed? Frequency Importance Follow up affects outcome Know what to do Where is follow-up most appropriate? Brainstorm What conditions are important under these criteria? Perhaps Diabetes Asthma COPD Hypertension ? Epilepsy High risk drug users ie DMARDs etc Contraception CDM Payments Asthma Diabetes Small fee per GP per year Criteria to claim Requirement for audit Ways and Means Opportunistic Dedicated clinics Nurse led clinics Specific appointments Disease registers Protocols Guidelines Better Care or Just PC Sometimes hard to tell! Evidence for effectiveness? Need for audit More work More treatment More iatrogenic problems? Polyclinic Model of Care The list of things can grow and grow. Advantages. Disadvantages. Professional satisfaction. Quality. Fragmentation. Fall between two stools. Generalist Model Copes with everything. Advantages. Disadvantages. Professional satisfaction. Holistic. Failure to care systematically. Registers Creation. Maintenance. Accuracy. Usage. Whose responsible? Manual viz. Computer. Protocols Authority. Ownership. Access. Who follows. Benefits. Disadvantages. GOBSAT viz. EBM. Records Whose responsible? Paper or computer? Accuracy. Meaning. Why poor? Audit PC or use? Who does? More work for what value? Do people change as a result? * *