Disease management: has it a future?

It has a compelling logic, but needs to be tested in practice

Education and debate p 563, 566

Disease management, often known as integrated care or care pathways, has wide appeal for health care reformers keen to contain costs and improve outcomes. 1 2 Integrated care is a key plank in the government's NHS modernisation programme.3 It is also particularly relevant to chronic illness.

Disease management commands wide international support as the optimal approach to planning and delivering health care.4 It is welcomed as a structured systems response to a set of problems that are evident to some degree in all health services. These include uncoordinated arrangements for delivering care, a bias towards acute treatment, a neglect of preventive care, and inappropriate treatment. The theory behind disease management is that resources can be used more effectively if the patient becomes the pivot around which health care is organised.5 In place of functional divisions, such as those between primary care and hospitals or between different clinical specialties, the divisions …