Infrastructural failure, rather than noncompliance, is the underlying cause of poor chronic care management in the U.S., according to Paul Farmer, MD, in an article in the New England Journal of Medicine.
The failure of chronic care management, a significant financial burden to the healthcare system, stems from a delivery gap — a breakdown between effective therapies and delivery systems that are able to bring those therapies to the populations needing them most.
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Dr. Farmer cites his experiences with his nonprofit healthcare organization, Partners in Health, an organization that focuses on bringing treatment for infectious diseases and disease prevention to poor and inaccessible regions of developing countries through partnering with local organizations. Partners in Health has found significant success in working with local resources to develop care delivery systems that have greatly increased the health of local people in several countries. In particular, Dr. Farmer shares five lessons for improving care delivery from his experience in treating drug-resistant tuberculosis:
1) Drug resistance is here to stay, but the state of emergency is controllable.
2) Better delivery platforms for care lead to improved clinical outcomes, assuming treatments are effective.
3) Patients who do not need to be inpatients should receive community-based care to save money and resources.
4) Treatments should have equitable delivery, which may require new financing systems.
5) "Untreatable" is an unhelpful term for any disease, as patients and family members may continue to seek out treatment anyway.
The "know-do" gap — plentiful resources and proven outcomes but persistent health disparities — for chronic care in the U.S. stems from the same care delivery problems as in areas with few resources, according to Dr. Farmer. To improve chronic health management, he recommends advocacy for better platforms of care delivery for the people who need it most.
Note: Dr. Farmer is the subject of a critically acclaimed book, Mountains Beyond Mountains, written by Tracy Kidder.
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