Integrated Disease Management
Comprehensive integrated care, self-care, patient support and education, training for healthcare workers to improve the quality of care: This team works to facilitate and support the strengthening of the capacity and competencies of the health system for the integrated management of chronic noncommunicable diseases (CNCDs) and their risk factors. These functions are among the core elements of the CARMEN Network and the Regional Strategy for Chronic Disease Prevention and Control. The team follows the Chronic Care Model, as described below. Also click below for a list of relevant documentation and resolutions.
The current acute health care model has not proven effective in dealing with prevention and management of chronic conditions. Successful chronic disease programs require an intersectoral approach and a reorientation of the healthcare system. It is necessary to improve the accessibility and availability of services and access to essential medicines and to have multidisciplinary health teams with the appropriate skill mix delivering services. Emphasis is needed on quality of care to reduce barriers related to social, economic, and cultural factors and to improve social protection for health, particularly among vulnerable populations.
In order to face these challenges, PAHO's action plan considers that prevention and management of chronic diseases requires integration through strengthened referrals and relationships among primary, secondary, and tertiary levels of care. The entire spectrum of disease management from prevention to screening and early detection, diagnosis, treatment, self-care, rehabilitation, and palliative care is necessary.
The constructs of the Chronic Care Model1 shown above are incorporated into the objective for the management of chronic diseases and risk factors, and are aimed at improving outcomes in five main areas:
- A coherent approach to system improvement.
- Development and adherence to guidelines.
- Self-management support for people with chronic diseases.
- Improved clinical information systems.
- Appropriate skill mix and improved technical competency of the health work force, including cultural competence and sensitivity.
This plan also considers technical assistance for chronic disease programs, the reorientation of health services towards chronic diseases, and improved access to essential medicines and technologies.
PAHO's strategy recognizes the call for a renewed approach to primary health care and the highest attainable level of health for everyone as emphasized in the Regional Declaration on the New Orientations for Primary Health Care (promulgated at the 46th Directing Council). Also reflected in this plan is Resolution CD45.R7: Access to Medicines, which prioritizes access to medicine and other health supplies.
- Survey on Diabetes, Hypertension and Chronic Disease Risk Factores: Central America | español
- Building Blocks in Diabetes Education and Control: A Framework for Comprehensive Diabetes Care | Paso a paso en la educación y el control de la diabetes: Pautas de atención integral
- Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7, NIH/NHLBI; PAHO translated this into Spanish at the request of its Member States to broaden its audience)
- PAHO-CDC Collaboration in Cancer: Supporting PAHO's 7-Point Action Plan for Cervical Cancer Prevention and Control, Including Cancer Registries (Atlanta, April 2009): English | español
- Latin American Diabetes Association Guidelines for the Diagnosis, Control, and Treatment of Type 2 Diabetes: Guías ALAD de diagnóstico, control y tratamiento de la Diabetes Mellitus Tipo 2
- Caribbean Chronic Care Collaborative / Caribbean Diabetes Project (CCCC/CARIDIAB) | español: Documentation listed below:
- Pilot for the new approach: VIDA Project | español
- Prevention and control of noncommunicable diseases: implementation of the global strategy (World Health Assembly Resolution WHA61.14): English | español | français
- Regional Strategy and Plan of Action for Cervical Cancer Prevention and Control (PAHO Resolution CD48.R10 2008): English | español | português | français
- Regional Strategy on an Integrated Approach to the Prevention and Control of Chronic Diseases Including Diet, Physical Activity, and Health (PAHO Resolution, CD47-17 2006): English | español | português | français
Executive Summary: English | español
Abstract:The Strategy is comprehensive, requiring a combination of interventions for the population and individuals. It is integrated, spanning prevention and control strategies focusing on the major chronic diseases and cross-cutting risk factors (especially physical activity, tobacco, and alcohol). Finally, it is intersectoral, because most of the major determinants of the chronic disease burden lie outside the health sector.
- Health Promotion (PAHO Resolution CD47-16, 2006): English | español | português | français
- Regional Strategy and Plan of Action on Nutrition in Health and Development, 2006–2015 (PAHO Resolution CD47-18, 2006): English | español | português | français
- Cancer Prevention and Control (World Health Assembly Resolution WHA58.22, 2005): English | español | français
- Global Strategy on Diet, Physical Activity, and Health (World Health Assembly Resolution WHA57.17, 2004): English | español | français
- Public Health Response to Chronic Diseases (PAHO Resolution CSP26/15, 2002): English | español | português | français
- Cardiovascular Disease, especially Hypertension (PAHO Resolution CD42.R9, 2000; pp. 16–19): English | español
- Prevention and Control of Noncommunicable Diseases (World Health Assembly Resolution WHA53.17, 2000): English | español | français
1 Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, Carver P, Sixta C. Quality Improvement in Cronic Illness Care. A Collaborative Approach. J Quality Improvement 2001;27(2):63-80.
Last Updated on Friday, 08 February 2013 16:37