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a solution for managing chronic disease

a solution for managing chronic disease. Medical Rehabilitation. M ihai Berteanu. “ Diagnosis ” alone fails to predict:. service needs ( National Advisory Mental Health Council 1993) length of hospitalization (McCrone and Phelan, 1994) level of care (Burns, 1991)

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a solution for managing chronic disease

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  1. a solution for managing chronic disease Medical Rehabilitation Mihai Berteanu

  2. “Diagnosis” alone fails to predict: • service needs(National Advisory Mental Health Council 1993) • length of hospitalization(McCrone and Phelan, 1994) • level of care(Burns, 1991) • outcome of hospitalization(Rabinowitz et al, 1994) • receipt of disability benefits(Massel et al, 1990) • work performance(Gatchel et al, 1994; Massel et al, 1990) • social integration(Ormel et al, 1993).

  3. Dx + “Disability” can predict: • health service utilization (Von Korff et al, 1992; Ormel et al, 1993) • Length of Hospitalization(Horn, 1990) • improvement in functioning after hospitalization(Rabinowitz et al, 1994) • return to work(Hlatky et al, 1986) • work performance(Massel et al, 1990) • recovery of social integration(Tate, 1989)

  4. Major changes in Health care • Prevalence of chronic > ac disease • Focus on consequences of disease, more than on disese itself • Persons w. disability have special needs

  5. Chronic disease = DISABILITY

  6. Epidemiology of disability • 10% general population (AM Chamberlaine, AB Ward 1996) Indicators: • HALE: Healty Life Expectancy • DALY: Disability-Adjusted Life-Years • Not only based on ethiological diagnoses

  7. Disability => REHABILITATION • DeNayer 1996: “if we resuscitate we rehabilitate” • Rehab. reduces burden of disability for individual and society • Enhances individual functioning and independent living

  8. Rehabilitation Aim • Enable people w. disability to attain their maximal physical, psycological, social, vocational and educational capacity by: • Overcome impairments • Reduce barriers to participation • Support reintegration into society • Reduces cost of dependency

  9. Rehabilitation • Medical act UEMS 2008 • ICHI: preventive, curative, +rehabilitation interventions (2009)

  10. WHO-ICF 2001biomedical vs. integrative model of functioning

  11. ICF 2001 applications • statistical tool • research tool • clinical tool • social policy tool • educational tool

  12. Medical Rehabilitation an obligation for managing chronic disease

  13. Disability & Human Rights • UN declaration of Human Rights 1994: • Not patient but citizen w. special needs • Council of Europe 2003 – Declaration of European Ministers • WHO Assembly Resolution 58.23 • Access to rehab = basic Human Right

  14. PRM in Rehabilitation sectors Long-term Rehabilitation Acute (early) Rehabilitation Post-acute Rehabilitation intensity In-patient or day clinic rehabilitation for patients with chronic conditions PRM in (acute) Hospital (ARU* and PRT**) PRM in post-acute rehab department (in-patient and day-clinic) PRM in community based rehabilitation and out-patient PRM services time * ARU = Acute Rehabilitation Unit ** PRT = Peripatetic Rehabilitation Team

  15. Assistive technology • Telemedicine • AAL

  16. White Book on PRM in Europe

  17. Prevention • Health Resort Medicine !

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