Theoretical Framework Medical Models And Chronic Disease Management

Evidence-based medicine is a dominant mantra currently, and correctly stresses the importance of using a systematic search for efficacious treatments (Sackett et al., 2000). An afterthought of this approach is the larger factors that may also influence outcomes, such as patient treatment preference (Bedi et al., 2000; Lin & Parikh, 1999), local health system resources, and practitioner characteristics and training (Donohoe, 1998; Parikh et al., 1997a). Several theoretical models provide guidance on how to understand these other relevant factors—models looking at "population health" (Ibrahim et al., 2001) or the "determinants of health" and models explicitly designed for chronic disease management. In fact, in the leading model of chronic disease management (Wagner et al., 1996), four categories of intervention have been identified: (1) practice design (reorganization), (2) patient education, (3) expert systems (provider education, guidelines, and decision support), and (4) computer-based support (reminder programs, feedback of automated clinical measures, or alerts to the clinician on matters such as nonrenewal of prescribed medications). By blending these models into a hybrid, which reflects the perspective of the clinician, it is possible to look at treatment success as a product of successful negotiation of barriers at three key levels: patient, provider, and system.

Letting Go, Moving On

Letting Go, Moving On

Learning About Letting Go, Moving On Can Have Amazing Benefits For Your Life And Success! Don't be held back by the past - face your guilt and fears and move on! Letting go is merely arriving at a decision, no more allowing something from the past tense to influence your life today or to cut down your inner sense of peace and welfare.

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