Access and Utilization of New Antidepressant and Antipsychotic Medications. Patient Compliance and Disease Management


Faced with rising health care costs and limited resources health care providers seek new ways to provide high-quality, cost-efficient care, especially for patients with chronic illnesses such as depression and schizophrenia. Several years ago, disease management emerged as a promising innovation with the potential to achieve this goal. The Boston Consulting Group first used the phrase "disease management" in its current sense in a 1993 report. Since that time, disease management techniques have been adopted and applied in a variety of delivery settings in the private sector and in Medicaid primary care case management.

Disease management is a term used to define various systematic, integrated approaches to the complete management of a disease state. In contrast to the compartmentalized delivery of health care that has traditionally been the norm in the United States, disease management uses a patient-centered approach to provide all components of care, and focuses on both quality and total cost. This approach includes coordination of physician care (e.g., primary care, specialty care) with pharmaceutical care and institutional care as well as various components of a disease state (e.g., co-morbidities of diabetes mellitus such as hyperlipidemia and renal disease). In addition to emphasizing continuity of care and a multidisciplinary approach, disease management also promotes patient empowerment through health education and encourages compliance with successful treatment programs, including medication.

Although formal disease management programs appear to be more common for physical illnesses such as diabetes and asthma, the utility of these programs in the treatment of severe mental illnesses such as depression and schizophrenia should not be overlooked.