Healthcare Quarterly

Healthcare Quarterly 12(2) April 2009 : e1-e13.doi:10.12927/hcq.2009.20598
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Changing Healthcare: Stakeholder Perceptions of the Burden of Chronic Disease and the Value of Teams, Measurements and Communication

Terrence Montague, Amédé Gogovor, Marilyn Krelenbaum, Sara Ahmed, Erica Berman, Minda Miloff and Bernard Burnand

Canadian healthcare is changing. Over the course of the past decade, the Health Care in Canada Survey (HCIC) has annually measured the reactions of the public and professional stakeholders to many of these change forces. In HCIC 2008, for the first time, the public's perception of their health status and all stakeholders' views of the burden and effective management of chronic diseases were sought. Overall, Canadians perceive themselves as healthy, with 84% of adults reporting good-to-excellent health. However, good health decreased with age as the occurrence of chronic illness rose, from 12% in the age group 18-24 to 65% for the population ≥65 years. More than 70% of all stakeholders were strongly or somewhat supportive of the implementation of coordinated care, or disease management programs, to improve the care of patients with chronic illnesses. Concordant support was also expressed for key disease management components, including coordinated interventions to improve home, community and self-care; increased wellness promotion; and increased use of clinical measurements and feedback to all stakeholders. However, there were also important areas of non-concordance. For example, the public and doctors consistently expressed less support than other stakeholders for the value of team care, including the use of non-physician professionals to provide patient care; increased patient involvement in decision-making; and the use of electronic health records to facilitate communication. The actual participation in disease management programs averaged 34% for professionals and 25% for the public. We conclude that chronic diseases are common, age-related and burdensome in Canada. Disease management or coordinated intervention often delivered by teams is also relatively common, despite its less-than-universal acceptance by all stakeholders. Further insights are needed, particularly into the variable perceptions of the value and efficacy of team-delivered healthcare and its important components.

Things are changing in Canadian healthcare. The population is aging and age-related chronic diseases are increasing. Access to care is becoming more difficult; many people have no family physician. Costs of care are rising. New care paradigms are evolving. Health professionals and the public - the stakeholders most directly involved in planning and implementing interventions to enhance health and manage disease - increasingly desire a more efficient and effective health system.

Over the course of the past decade, the Health Care in Canada Survey (HCIC) partnership has sampled public and professional perceptions regarding the key issues and opportunities for improvement in the health environment. A major focus of the 10th anniversary edition of HCIC was seeking stakeholders' perceptions of the burden of chronic diseases and the value of collaborative interventions for their effective management (Health Care in Canada Survey 2008). This article summarizes the results.



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