Socioeconomic factors, disabilities, and comorbid conditions are obstacles

Papers pp 962, 968 See also Primary care p 970

This special issue of the BMJ and this month's issue of the Western Journal of Medicine once again focus on the needs of patients with chronic illness, on the advances in clinical and behavioural management, and on the challenges of assuring that patients receive optimal care. Achieving such optimal care challenges both patients and their care givers. This is especially so in developing countries, which are facing rapid increases in the prevalences of major chronic diseases.

Evidence based care for many chronic illnesses requires increasingly complicated drug regimens, ongoing support of self management, and close monitoring. Articles in this week's BMJ describe modern management for coronary heart disease, diabetes, asthma, and anticoagulation therapy. They emphasise that achieving the best possible outcomes depends on competent self management and decision making by patients, as well as clinical treatments.

But audits and surveys …