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Changes in health care delivery and financing are needed to meet the unique needs of older women with chronic conditions

Over 80 percent of women between the ages of 65 and 85 report at least one chronic disease such as diabetes, arthritis, or hypertension; half report more than one; and one-fourth report three or more chronic conditions. Developing successful chronic care systems for the growing number of elderly women requires radical practice redesign and patient education, according to Agency for Health Care Policy and Research investigators, Arlene S. Bierman, M.D., M.S., and Carolyn M. Clancy, M.D.

In a recent review and synthesis, they point out that managed care organizations are for the first time enrolling large numbers of chronically ill and elderly individuals and may not be adequately prepared to meet the needs of these patients for care that will improve functioning and lead to a better quality of life. Medical practices need to be reorganized and reimbursement mechanisms made sufficient and flexible enough to allow physicians more time for patient education, counseling, and case management to prepare these women to self-manage their illnesses. These objectives cannot be met in a brief office visit; they require a practice and organizational infrastructure and multidisciplinary team that can support the objectives, explain the researchers.

Drs. Bierman and Clancy point out that new models of health care delivery and financing are needed to provide quality care for chronic illness. For example, insurance benefit structure and coverage decisions will affect the availability of pharmaceuticals, durable medical equipment, home care, and other supportive services. Also, physicians need to be trained in functional assessment, must have good communication skills, sensitivity to the needs of diverse populations, the ability to work within a multidisciplinary team, and knowledge of supportive services available in the community, note the researchers. The authors emphasize that there is a need for rigorous evaluation of interventions and models of care aimed at improving health outcomes for the chronically ill. The article provides a checklist that can be used to guide the evaluation process.

In conclusion, the researchers note that the ultimate challenge for improving women's health requires developing integrated comprehensive programs to address the continuum of women's health needs: preventive, reproductive, acute, and chronic care. Women suffer from a higher burden of illness and disability than men, and they have unique health needs across the life span. As the Nation's health care system struggles to make the long overdue transition from a primary focus on treating illnesses in individuals to a broader focus on the promotion of health and well-being in the population, the challenge will be to align organizational and financial structures and incentives with health needs.

See "Women's health, chronic disease, and disease management: New words and old music?" by Drs. Bierman and Clancy, in the January/February 1999 Women's Health Issues 9(1), pp. 2-17. Reprints (AHCPR Publication No. 99-R052) are available from the AHCPR Publications Clearinghouse.

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