For Chelle Del Rosario, a stay-at-home mom and blogger who has been diagnosed with ten chronic conditions, there’s no such thing as an average day-in-the-life. “I would love to have a more structured day but each day greatly depends on how I feel each morning,” she writes. “I could wake up and just feel absolutely horrendous. I could wake up cranky because my medications prevented me from sleeping. I find myself constantly apologizing because there are times when I would just snap out of nowhere.”
For Chelle, and millions of others around the world, managing chronic conditions, health care is a lot more complicated than just squeezing in an annual checkup. According to the World Health Organization, chronic disease is a growing, global problem. In 2001, chronic conditions were responsible for 60% of the total reported deaths—56.5 million people. That’s a number equivalent to the entire population of South Africa.
Canadians fare slightly worse than the global average when it comes to chronic conditions. According to a 2013 report by the Public Health Agency of Canada, 67% of all deaths per year are caused by four major chronic diseases: cancer, diabetes, heart disease and chronic respiratory diseases, such as asthma and pulmonary hypertension. The report also notes that three out of five Canadians 20 and older have a chronic condition, while four out of five are at risk for developing one. That means the majority of Canadians are living with chronic diseases that affect their health and wellbeing.
Costs of chronic disease
In addition to costing lives, chronic conditions are expensive. In total, the Chronic Disease Prevention Alliance of Canada (CDPAC) estimates that chronic diseases and other illnesses cost the Canadian economy $190 billion annually. That number represents about $122 billion in indirect income and productivity losses and $68 billion in direct health care costs. That means chronic diseases directly account for about 58% of the annual health care spending in our country.
Plus, nearly 80 percent of patients drop out of their chronic disease management programs, which sets them up for complications and more expensive conditions down the road.
What is a chronic condition?
According to the Center for Disease Control (CDC), chronic conditions meet several criteria. They are long-lasting, require ongoing medical attention, and tend to limit daily activities. Major chronic diseases include heart disease, cancer, and diabetes. Keep in mind that the term refers to both physical conditions (heart disease, diabetes, and asthma), as well as mental conditions like anxiety and depression.
While there are preventable chronic conditions caused by lifestyle choices—not exercising, poor diet, tobacco use, and alcohol consumption—many others are unpreventable. For example, while you can avoid Type 2 diabetes through diet and exercise, Type 1 diabetes (also known as juvenile-onset diabetes) is an unpreventable autoimmune condition with no cure.
Roadblocks to managing chronic conditions
A 2017 survey from Kelton and West Healthcare showed that 80 percent of patients know they need to improve their chronic care self-management, but require a provider’s help to do so.
According to Lisa Roome-Rago, the Director of Enterprise Outpatient Care Management at Advocate Health Care, there’s no such thing as a genuinely noncompliant patient. Often, they’re just lost or overwhelmed. “People don’t wake up in the morning and think ‘I’m not going to follow what my doctor told me to do today,’” Roome-Rago asserted. “It’s a matter of figuring out what’s actually going on and then trying to create a plan around that and minimize as many barriers as you can.”
The myriad roadblocks to managing chronic conditions include symptoms of the condition itself, continuity in healthcare, prohibitive costs, and trouble managing or affording prescriptions.
The condition itself
Consider the steps it takes to get to a doctor’s appointment. You wake up, get dressed, eat breakfast, brush your teeth, find your phone, wallet, and keys, walk outside, start the car, drive to the office, check-in at the front desk, wait in the waiting room, wait in the exam room, interact with the doctor… Are you tired yet?
If you’re one of the millions living with a chronic condition, you understand how your symptoms can make seemingly simple tasks feel insurmountable. You spend too many spoons trying to balance your life and medical care. Plus, considering most modern clinics practice “sick” care, not health care, waiting rooms are potentially dangerous for people who are immunocompromised.
Lack of continuity
Managing chronic conditions requires streamlined, coordinated efforts between you, your general practitioner, and your team of specialists. Especially if you’re managing multiple conditions where treatments might be contraindicated. Continuity means your concerns get addressed at every step of the care cycle, by every person on your medical team. Unfortunately, today’s health system is fragmented, which impacts the quality, cost, and outcome of care plans.
Consider Chelle’s example again. “I take a lot of medications, and each of their schedules are different,” she writes. “I need to take a certain medication once a week. Most of my medications I take daily. Some of them can’t be taken together, or I have to eat before taking them. I just can’t keep track of all of them, and my phone saves me the worry of missing a dose.” People managing chronic conditions often take several medications, and each of those prescriptions may come from a different specialist. Managing to take them consistently is one thing. Remembering to reorder them on time is another.
Luckily, most Canadians have access to insurance coverage for prescription drugs through a patchwork of public and private insurance plans. Others are not so lucky. For uninsured Americans living with Type 1 diabetes, insulin and testing strips cost nearly $1,000 each month. The average price for one Advair inhaler, a leading medication for asthma, increased from $316 in 2013 to $496 in 2018. If those costs are out-of-pocket, people managing chronic conditions may have to choose between their medication and their mortgage.
How we’re solving accessibility issues
Many measure telemedicine’s effectiveness in terms of acute problems—the sudden, unexpected onset of symptoms. But many physicians think chronic condition management is one of its most promising aspects. By increasing accessibility, making visits more affordable, and creating one convenient access point for medical records, telehealth startups like Lumeca are making it easier to manage chronic conditions.
The doctor can see you now
Accessibility, in particular, is crucial to managing chronic conditions. For patients seeing multiple specialists or patients living in rural areas, finding the time for follow-up care can be impossible. Often, seeing a specialist requires a long commute and may even mean staying overnight in another city. By allowing patients to connect with specialists from the comfort of their own homes, virtual health consultations increase compliance with doctor recommendations.
For the newly diagnosed, following up with a specialist is often a frustrating waiting game. In fact, long wait times and delays are the number one reason many Canadians let their management plan fall through the cracks. But Lumeca allows patients to connect with their specialists, anytime, anywhere, at the touch of a button.
Plus, with video capability, specialists and general practitioners alike can interact directly with their patients. Healthcare providers at the Complex Chronic Disease Program (CCDP) noted: “A major benefit to staff is that we’re able to see a patient’s demeanour, their emotional fluxes, and make assessments not possible with telephone consults.” CDCCP is the only provincial program providing care for complex chronic diseases such as Chronic Fatigue Syndrome, Fibromyalgia, Multiple Chemical Sensitivities, and symptoms attributed to Chronic Lyme Disease. For their staff, virtual health is an efficient way to provide high-quality healthcare to their entire patient base.