title: Chronic disease management: the primary care perspective.
abstract: This response to the essay is a "view from the trenches" by two doctors who have worked over 23 years at the Group Health Centre in Sault Ste. Marie, Ontario. We would agree wholeheartedly that reducing wait times for selected procedures will not transform our health system, although they are a start that does provide improved quality of life for a relatively small number of people. We have struggled with the care gap between known best practices and the reality of care provided, from the perspectives of both prevention and chronic disease management. This has resulted in an acute awareness of the need for an across-the-system, "bottom-up" approach to the prevention of disease and management of healthcare. Limited resources must be carefully leveraged in innovative ways if we are to eliminate this care gap, decrease morbidity and minimize expensive "rescue" procedures that make our system increasingly unaffordable.
authors.affiliation: Algoma Diabetes Education Centre, Member of the Health Promotion Initiatives Team, Group Health Centre.
authors.forename: Pauline
authors.initials: P
authors.lastname: Bragaglia
authors.forename: Lewis
authors.initials: L
authors.lastname: O'Brien
mesh_terms: D002170:Canada; D002908:Chronic Disease / Q000191:economics / Q000517:prevention & control* / Q000628:therapy*; D019468:Disease Management; D015276:Health Care Rationing / Q000458:organization & administration; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration