Dr. med. Christian Flügel-Bleienheuft
Dr. Flügel-Bleienheuft is a resident specialist in internal medicine in Cologne and chairman of the board of directors of the Cologne-South Health Network.
Dr. Bleienheuft, "chronically ill" is a term that is used as a matter of course. What describes a chronically ill person, or better: When do you list patients as chronic in your practice?
Chronic diseases require long-term and continuous therapy and care, i.e. therapy and care that lasts until the end of life. Chronic diseases of this kind can start in old age, such as arterial hypertension, or even at a young age, such as insulin-dependent type I diabetes mellitus. By definition, one is chronically ill if one required medical care at least once a quarter in the past year.
A chronic illness requires long-term behavioral changes on the part of the patient, be it through medication or lifestyle changes. What is your experience in terms of "compliance". How well and for how long do chroniclers stick to the necessary changes and what tips do you have to support the changes.
It is important for chronically ill people to have an understanding of their illness, i.e. a high level of health literacy. This means that they know about the circumstances under which it came about and the available therapy options and their own options in the therapy of their chronic disease. With an understanding of their own illness, it is understandable and possible for the chronically ill person to implement a therapy concept together with the doctor in charge, we also speak of shared decision here. This procedure leads to a significantly increased compliance and therapy adherence and thus an improvement in the quality of therapy.
How good are the chances of ending the chronic status? Is there any experience or data that shows how many people recover from a chronic illness?
I am not aware of any data on how many people recover from a chronic disease. Cancer, for example, is also a chronic disease, and it may be the case that surgery, possibly in combination with radiation and chemotherapy, leads to recovery. But here, too, “chronic” follow-up observation is necessary for years, i.e. chronic medical care remains, possibly without drug therapy, but the affected person adapts to this “chronic” disease in their living conditions.
Disease management programs (dmp), structured treatment programs, are established in the treatment of chronically ill people. What about the prevention of chronic diseases? Do we have offers for this in Germany and where do we still have deficits in the area of prevention?
There are very good DMP programs for diseases such as diabetes mellitus, coronary heart disease, breast cancer and chronic back pain. When it comes to prevention, it looks rather bleak, which certainly has complex reasons. Prevention is actually a measure that should begin as early as childhood and school age with a healthy diet and adequate exercise. This should continue throughout life and be supplemented by comprehensive information on increasing health literacy. Most of the time, we all only become active when something pinches or tweaks us. So motivation to take the initiative is certainly necessary here. Prevention also includes check-ups offered by the health insurance companies, including a check-up every two years from the age of 35, colonoscopy as a check-up for men from the age of 50 and for women from the age of 55 every 10 years, as well as the extensive gynecological check-ups.
But I see the greatest challenge in the sustainable promotion of "healthy living" with appropriate nutrition and sufficient exercise to avoid obesity, disorders of the musculoskeletal system, diabetes and hypertension and circulatory disorders.
I see another challenge, for example, in the early detection of atrial fibrillation, a cardiac arrhythmia that can lead to a stroke. There are already corresponding tools and wearables that can be used, but are not yet in widespread use.
What is your experience with prevention? Do most of your patients live a "preventive" conscious lifestyle, or do they need a "nudge" health talk from their doctor to make a difference?
As I said above, we often only go to the doctor when there is a tweak or pinch, so most people in our latitudes see their quality of life in good food and drink. Approaching the doctor can only fall on fertile ground as a preventative measure if the health competence mentioned above is high.
You can find our comprehensive information on the stage chronically ill here.