Health and disease management: what is it and where is it going? What is the role of health and disease management in hypertension?

Health and disease management, a clinical improvement process that integrates best practice principles in a comprehensive manner throughout the entire continuum of care, is likely to be the dominant style of health care delivery in the future. The goal of these programs is to eliminate or reduce unacceptable variations in cost and quality between various providers by developing guidelines that will achieve measurable outcomes for specific diseases. These protocols also emphasize wellness and disease prevention, coordinate resources across the entire continuum of care, and define interventions for the entire duration of the disease. Conditions most suited to this management strategy include diseases that are of high volume and cost, complex to manage, and present chronically over a long period of the patient's life. Such programs are developed by a multidisciplinary team that is also charged with obtaining buy-in and championing the program to their peers. Among the many components of a comprehensive health and disease management program, intensive education for patients and families and altering physician behavior to obtain compliance are key areas on which to focus. Hypertension is an ideal condition to manage in this way. It is frequently the most common reason for patients to be seen by a primary care provider, is an expensive disease to treat, and is an important cause of major organ damage from inadequate treatment. Successfully adopting a disease management model for hypertension treatment that will integrate all health care providers and offer intensive education of patients and providers to encourage adherence to the highly effective therapies currently available should afford a major opportunity for a dramatic reduction in complications and costs, with enhanced clinical outcomes and quality of life for these patients.