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This challenge is set against a backdrop of rising healthcare costs, a fragile economic landscape and pressure on public funding. In the UK, it has been well documented that the NHS needs to find savings of between £15 and £20bn by 2014.
As is the case for many other developed countries, an increasingly large percentage of the population is living with long term conditions such as diabetes or heart disease. In the UK, people with such conditions account for 69% of the NHS's primary and acute care budget. 15.4m people in the UK have a long term condition and, worryingly, this is set to rise by 23% over the next 25 years.
As a result, encouraging these patients to manage their own care better is increasingly being considered to be a good way of improving their health and reducing how often they use the health service. This is particularly relevant as NHS Self Care Week ramps-up efforts to help people to understand how to improve their health by making simple lifestyle changes like taking gentle exercise.
The bottom line
While the benefits of engaging people with long-term conditions to manage their health better in this way should not be understated, disease management alone should not be overemphasised.
The way people with long term conditions manage their health varies, so the best care requires a whole person approach. This means personalised support and shared decision making regarding choices about different treatments, and use of clinical data to determine where support is needed most.
By viewing care management in this integrated way, it is clear to see how it could have a powerful effect on patient outcomes. However, until now there has been much debate about the efficacy of care management with most studies proving inconclusive regarding financial savings.
However, an encouraging study recently published in the New England Journal of Medicine suggests that care management may be an effective way to meet the challenges of improving the quality and productivity of healthcare.
In a randomised study in the United States, over 170,000 patients were provided with personalised telephone-based nursing support over a 12 month period. The result was that emergency hospital admissions were 10% lower in the intervention group and rates for a number of surgical procedures were 9.8% lower.
Overall, the service delivered a staggering 6:1 return on investment.
Improving outcomes
With the number of people living with long-term conditions growing, it would seem reasonable to conclude that the healthcare systems around the world will have to manage increased healthcare demand.
Encouragingly, however, studies such as the randomised trial highlighted here show us that by working with the resources that we have available in a more joined-up way, not only can we better control the money that is spent on long term conditions but that we can also make real improvements in the quality of life of people living with these conditions.
Dr Steve Hajioff is a GP, public health consultant and chief clinical adviser to Bupa Health Dialog
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