Abstract
Chronic diseases are recognized as a leadingcause of mortality, morbidity, health careutilization and cost. A constant tailoring ofcare to the actual needs of individualpatients, complexity and long duration are thedistinguishing features of chronic diseasemanagement.
Given the rapid development and high use ofservices providing complex management, thenumber of controlled clinical trials in thisfield is limited. The information from the fewavailable controlled clinical trials may bedifficult to interpret, mainly due to a largevariety in the interventions being studied,differences in `control treatments' and aconfined set of outcome measures that are used.The ethical issue with this observation is,that in the absence of randomised clinicaltrial information on clinical effectiveness andin consequence of the lack of additional datathat are crucial for therapeutic decisions inthe process of caring, specific patient groups,such as patients with chronic diseases, maybecome disadvantaged.The scarcity and incompleteness of controlledtrial information can partly be explained bydifficulties in conducting this type ofresearch in the field of chronic diseasemanagement.
To avoid that patients with chronic diseasesbecome disadvantaged, the use of alternativedesigns such as observational studies toevaluate chronic disease management must beaccepted and supported. Moreover, in chronicdisease management the process of caring needsto emphasized and appraised appropriately. Forthat purpose, new measurement methods,focussing on concepts of caring that are notincluded in the majority of current clinicaltrials, need to be developed.
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Vliet Vlieland, T.P. Managing Chronic Disease: Evidence-Based Medicine or Patient Centred Medicine?. Health Care Analysis 10, 289–298 (2002). https://doi.org/10.1023/A:1022951808151
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DOI: https://doi.org/10.1023/A:1022951808151