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Disease Management: A Perfect Fit for Public Health Nurses, Workers

Posted on: Saturday, 6 August 2005, 03:01 CDT

Perspectives of the president of APHA

ONE OF the most important developments from America's shift to managed care has been the creation of disease management programs. Such programs provide coordinated chronic disease care using health education, self-management and dietary and medication compliance to reduce disease complications and improve health status. For insurers, better disease management can be a boon, reducing rehospitalizations, emergency room visits and medical costs.

Disease management has developed into its own for-profit industry, with multiple insurers, pharmaceutical companies, large corporations and niche groups carving out a variety of programs - but only for those who are covered by specific insurance or employer plans. By offering disease management solely for those whose lives are covered, we have created a forest of programs. Many of these programs are nothing more than phone call centers and are too small to create significant savings.

Sadly, disease management programs have developed largely outside of the public health field and to the particular detriment of public health nursing. The U.S. Health Resources and Services Administration found in 2002 that the number of nurses in America will increase in coming years in every employment setting except for public health, which will lose 4,000 nurses by 2020.

Suppose we did something radical, such as making disease management a public health function. Could we really do this?

Fortunately, the basic elements are already present. At the heart of public health are professional health educators, community outreach workers, social workers and public health nurses who are not only involved in disease investigation, but more ideally, prevention. All health ' departments conduct home visits. Many contractually provide home care often for the most needy in their communities. Public health professionals are also geographically based and provide health education regardless of insurance status.

As a community resource, public health professionals could lead a variety of classes around diabetes education, smoking cessation, nutrition, asthma management, etc.

Since all health departments gather local statistics, including chronic disease survey data, they could match their education messages to the most important local health issues. Disease management programs could be community-based offerings, but with more intense in-home education for targeted patients.

In the old days, teams of nurses and outreach workers would be assigned to neighborhoods. They were well-known and respected and performed a variety of in-home services, from newborn visits to chronic disease assessment. As public health funding stagnated, these programs were often the first to go. It's time we took another look at such methods.

History has shown that our greatest improvements in health outcomes have come when communities cooperate for a common goal and we invest in public health nurses and health workers. Using workers whose professional mission is prevention and education to provide disease management would help us further those improvements.

Walter Tsou, MD, MPH

walter.tsou@apha.org

Copyright American Public Health Association Aug 2005

Source: Nation's Health, The

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