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TitleLiving Well with Chronic Illness: A Call for Public Health Action
LanguageEnglish
File Size2.4 MB
Total Pages351
Table of Contents
                            Front Matter
Summary
Introduction
1 Living Well with Chronic Illness
2 Chronic Illnesses and the People Who Live with Them
3 Policy
4 Community-Based Intervention
5 Surveillance and Assessment
6 Interface of the Public Health System, the Health Care System, and the NonHealth Care Sector
7 The Call for Action
Appendix A: Improving Recognition and Quality of Depression Care in Patients with Common Chronic Medical Illnesses--Wayne J. Katon
Appendix B: New Models of Comprehensive Health Care for People with Chronic Conditions--Chad Boult and Erin K. Murphy
Appendix C: Agendas of Public Meetings Held by the Committee
Appendix D: Committee Biographies
                        
Document Text Contents
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NATIONAL ACADEMY OF SCIENCES

NATIONAL ACADEMY OF ENGINEERING

INSTITUTE OF MEDICINE

NATIONAL RESEARCH COUNCIL

This PDF is available from The National Academies Press at http://www.nap.edu/catalog.php?record_id=13272

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350 pages
6 x 9
PAPERBACK (2012)

Living Well with Chronic Illness: A Call for Public Health Action

Committee on Living Well with Chronic Disease: Public Health Action to
Reduce Disability and Improve Functioning and Quality of Life; Institute of
Medicine

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Living Well with Chronic Illness: A Call for Public Health Action

Page 176

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Living Well with Chronic Illness: A Call for Public Health Action

COMMUNITY-BASED INTERVENTION 157

secondhand smoke, and those in the workplace increase smoking cessation
and decrease secondhand smoke exposure. In the workplace, incentives and
competitions can be effective in increasing tobacco cessation when com-
bined with other efforts. Recommended interventions for smoking cessation
include mass media campaigns when combined with other interventions, an
increase in the unit price of tobacco products, provider reminders with and
without provider education, reduced out-of-pocket costs for tobacco cessa-
tion, and multicomponent interventions that include telephone counseling
(Community Preventive Services Task Force, [a]).

Screening and Vaccination

USPSTF has developed recommendations for clinical preventive services
based on systematic reviews of the literature. With few exceptions, recom-
mendations of USPSTF apply as well to people with chronic illnesses as they
do to people without chronic illness. The only exceptions to general preven-
tion recommendations for people with chronic illnesses involve situations
where the presence of the chronic illness changes the magnitude of benefit
or harm from the specific preventive service. For example, if the chronic
illness reduces life expectancy to a substantial degree, the potential benefit
from the preventive service (e.g., screening mammography in women with
metastatic lung cancer) may be reduced and the preventive service becomes
inappropriate. Likewise, if the chronic illness increases the testing burden or
the potential psychological or physical harm of the preventive service (e.g.,
colorectal cancer screening in people with advanced dementia), again the
preventive service is inappropriate. As with individual preventive services
for anyone, it is important for the health care system to assist people with
chronic illnesses to consider the potential benefits and harms to make an in-
formed decision about preventive services. Sometimes, people with chronic
illnesses may decide that the burden of testing and possible work-up and
treatment is not worth the potential benefit, or that the added burden of yet
another medication (even if prophylactic) is more than they are willing to
bear. Some people with chronic illnesses may decide that, given their situa-
tion, some preventive services are just not a high enough priority for them
to spend the time and energy (both physical and emotional) to engage in
them. In these situations, the health care systems should respect and support
the person’s decision (Sawaya et al., 2007).

Chronically ill individuals often suffer from multiple chronic conditions
(MCCs) (HHS, 2010), and thus relevant outcomes for preventive interven-
tions may be broader than those traditionally used to assess effectiveness of
preventive services and include multiple domains. Some of these domains
may be represented by a multiplicity of measures that create difficulties for
clear, straightforward interpretation. The strategic framework on MCCs of

Page 350

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Living Well with Chronic Illness: A Call for Public Health Action

APPENDIX D 331

and an M.P.H. degree (1986) from the University of Minnesota. He has au-
thored or coauthored over 300 publications and teaches courses on public
health practice to undergraduate, medical, and public health students.

David B. Reuben, M.D., is director, Multicampus Program in Geriatrics
Medicine and Gerontology, and chief, Division of Geriatrics at the Univer-
sity of California, Los Angeles (UCLA) Center for Health Sciences. He is
the Archstone Foundation Chair and Professor at the David Geffen School
of Medicine at UCLA and director of the UCLA Claude D. Pepper Older
Americans Independence Center. Dr. Reuben sustains professional interests
in clinical care, education, research, and administrative aspects of geriatrics.
He has won seven awards for excellence in teaching and maintains a clinical
primary care practice of frail older persons and attends on inpatient, and
geriatric psychiatry units at UCLA. Dr. Reuben is a geriatrician-researcher
with expertise in studies linking common geriatric syndromes (e.g., func-
tional impairment, sensory impairment, malnutrition) to health outcomes
such as mortality, costs, and functional decline. He also has extensive ex-
perience with interventional research (e.g., comprehensive geriatric assess-
ment) that has focused on health care delivery to older persons. His most
recent work focuses on developing and testing interventions to improve the
quality of care that primary care physicians provide for geriatric conditions.

In 2000, Dr. Reuben was given the Dennis H. Jahnigen Memorial
Award for outstanding contributions to education in the field of geriatrics,
and in 2008, he received the Joseph T. Freeman Award by the Gerontologi-
cal Society of America. Dr. Reuben was part of the team that received the
2008 John M. Eisenberg Patient Safety and Quality Award for Research—
Joint Commission and National Quality Forum (NQF), for Assessing Care
of the Vulnerable Elderly (ACOVE). He is a past-president of the American
Geriatrics Society and the Association of Directors of Geriatric Academic
Programs (ADGAP). Dr. Reuben is past-chair of the board of directors of
the American Board of Internal Medicine. He is lead author of the widely
distributed book Geriatrics at Your Fingertips. Dr. Reuben has served on
four previous IOM committees and a NAS committee.

Michael Schoenbaum, Ph.D., is senior advisor for mental health services,
epidemiology, and economics in the Office of the Director at the National
Institute of Mental Health. In that capacity, he directs a unit charged
with conducting analyses of mental health burden, service use and costs,
intervention opportunities, and other policy-related issues, in support of
institute decision making. Dr. Schoenbaum’s research has focused par-
ticularly on the costs and benefits of interventions to improve health and
health care, evaluated from the perspectives of patients, providers, payers,
and society. Prior to joining NIMH, Dr. Schoenbaum spent 9 years at the

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