[New perspectives in the primary care of the chronically ill--against the "tyranny of the urgent". Part 2: The chronic care model und case management as the basis of a forward-looking approach to primary care].
Family medicine remains strongly influenced by reactive medicine ('tyranny of the urgent') and the fragmentation of healthcare associated with it. In the first part of the present article the increasing practical and economic relevance of chronic diseases and multimorbidity were analyzed as a fundamental challenge for primary care and family medicine in particular. Part two describes a forward-looking approach to guidelines and special tools which are able to guide and support future healthcare tasks of general practice. Wagner's Chronic Care Model, which was developed on the basis of numerous controlled studies, integrates empirical results, theoretical ideas and real experience within a comprehensive concept for the treatment of chronic diseases. The model focuses on the'productive interaction' between an active patient and a proactive practice team. The various elements of the model help to better understand healthcare in general practices, for example by establishing reminder and recall systems by means of a structured reorganization, through patient registers, the implementation of consultation hours for chronically ill patients as well as patient training. 'Case management' is essential to the success of structured care. Taking care of patients with major depression as an example, it is demonstrated how case management through practice assistants in general practices enables the individual needs of chronically ill patients to be better taken into account. The professionalism of the practice team with new roles and task sharing as well as the implementation of modern strategies for the care of chronically ill patients provide a new chance and a sharpened profile for general practices of the future.
Gerlach
Ferdinand M
FM
Institut für Allgemeinmedizin, Johann Wolfgang Goethe-Universität, Frankfurt am Main. gerlach@allgemeinmedizin.uni-frankfurt.de
Beyer
Martin
M
Saal
Kristina
K
Peitz
Monika
M
Gensichen
Jochen
J
D019090:Case Management / Q000592:standards*; D002908:Chronic Disease; D005858:Germany; D006801:Humans; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D011785:Quality Assurance, Health Care