The U.S. chronic illness burden is increasing and is felt more strongly in minority and low-income populations: in 2005, 133 million Americans had at least one chronic condition. Prevention and management of chronic disease are best performed by multidisciplinary teams in primary care and public health. However, the future health care workforce is not projected to include an appropriate mix of personnel capable of staffing such teams. To prepare for the growing chronic disease burden, a larger interdisciplinary primary care workforce is needed, and payment for primary care should reward practices that incorporate multidisciplinary teams. [Health Affairs 28, no. 1 (2009): 64-74; 10.1377/hlthaff .28.1.64] I n 2 0 0 5 , 13 3 m i ll i o n a m e r i c an s w e r e l i v i n g with at least one chronic condition. In 2020, this number is expected to grow to 157 million. In 2005, sixty-three million people had multiple chronic illnesses, and that number will reach eighty-one million in 2020. 1 Not surprisingly, the proportion of the population diagnosed with chronic conditions increases with age (Exhibit 1). More worrisome is the striking gap between the high prevalence of chronic conditions among people who are below the federal poverty level compared with the average prevalence in the general population. The cost burden of chronic illness-currently 78 percent of total health spending-will increase markedly by 2023 (Exhibit 2). The number of people with diabetes is expected to double in the next twenty-five years, from twentyfour million to forty-eight million. By 2023, the number of people with chronic mental disorders may increase from thirty million to forty-seven million. Similar increases are forecast for virtually every common chronic condition. 6 4 J a n u a r y / F e b r u a r y 2 0 0 9 R e o r g a n i z i n g C a r e n Reasons for increased prevalence. Reasons for the increased prevalence of chronic conditions are multifactorial-including an aging population plus a rise in disease-specific risk factors such as obesity. A comparison of chronic disease prevalence in the United States and in ten European countries reveals a markedly lower prevalence in Europe of heart disease, hypertension, diabetes, obesity, and arthritis. This difference may be attributable to a healthier diet and lower poverty rates in Eu- 4 The population over age eighty-five, the group with the highest proportion of people with multiple chronic conditions, is projected to grow from five million in 2005 to twenty-one million in 2050, ensuring a major increase in the number of very-high-cost patients.n Four policy questions. These data raise both general societal issues and specific policy questions. In this paper we address four specific policy questions, with greatest emphasis placed on questions 2 and 3: (1) Can dramatic public health prevention slow down the rate of increase of chronic disease prevalence? (2) Should chronic care be delivered chiefly by specialist physicians, generalist physicians, or multidisciplinary teams...

PURPOSE Poor blood pressure control is common in the United States. We conducted a study to determine whether health coaching with home titration of antihypertensive medications can improve blood pressure control compared with health coaching alone in a low-income, predominantly minority population.

Hepatitis C virus (HCV) infection is associated with substantial clinical and economic burden and is an important public health issue in Asia. The objective of this review was to characterize HCV epidemiology and related complications in China, Japan, South Korea and Taiwan. A search of electronic databases and conference abstracts identified 71 potentially relevant articles. Of those, 55 were included in the epidemiology review and 9 in the review of HCV-related complications. HCV prevalence in the general population was 1.6% in China, 0.6-0.9% in Japan, 0.6-1.1% in South Korea and 1.8-5.5% in Taiwan. Prevalence was higher for injecting drug users (48-90%) and those with human immunodeficiency virus coinfection (32-85%) and was lower for blood donors (<1%). Annual incidence of HCV in China was 6.01 per 100,000. HCV genotype 1b was associated with the highest incidence of hepatocellular carcinoma (HCC). Five-year survival for patients with liver cirrhosis was 73.8%, decreasing to 39.2% following liver transplantation; the majority of deaths were attributable to HCC. Limitations were that the majority of studies included in the epidemiology review were small, regional studies conducted in specific populations, and there was an absence of large population-based studies. Thus, estimates may not be representative of the epidemiology of HCV for each country. The prevalence HCV in China and HCV incidence in the Asian region remain largely unknown, and they are likely underestimated. Further epidemiologic and clinical data are needed to provide more precise estimates for use by public health agencies.

BackgroundDespite the many antihypertensive medications available, two-thirds of patients with hypertension do not achieve blood pressure control. This is thought to be due to a combination of poor patient education, poor medication adherence, and "clinical inertia." The present trial evaluates an intervention consisting of health coaching, home blood pressure monitoring, and home medication titration as a method to address these three causes of poor hypertension control.Methods/DesignThe randomized controlled trial will include 300 patients with poorly controlled hypertension. Participants will be recruited from a primary care clinic in a teaching hospital that primarily serves low-income populations.An intervention group of 150 participants will receive health coaching, home blood pressure monitoring, and home-titration of antihypertensive medications during 6 months. The control group (n = 150) will receive health coaching plus home blood pressure monitoring for the same duration. A passive control group will receive usual care. Blood pressure measurements will take place at baseline, and after 6 and 12 months. The primary outcome will be change in systolic blood pressure after 6 and 12 months. Secondary outcomes measured will be change in diastolic blood pressure, adverse events, and patient and provider satisfaction.DiscussionThe present study is designed to assess whether the 3-pronged approach of health coaching, home blood pressure monitoring, and home medication titration can successfully improve blood pressure, and if so, whether this effect persists beyond the period of the intervention.Trial RegistrationClinicalTrials.gov identifier: NCT01013857

The International Osteoporosis Foundation (IOF) has developed this toolkit to facilitate the implementation of Fracture Liaison Services (FLS). Used in conjunction with resources from the IOF Capture the Fracture ® initiative (www.capturethefracture.org), the toolkit gives those wanting to establish an FLS the case for, and the resources to, enable FLS expansion. WHAT'S IN THIS TOOLKITThe following tools are to support clinicians, health administrators and policymakers in the implementation of effective FLS based on successful experiences from established high performing FLS. Understanding the need for FLSA guide to understanding the size of the problem and why FLS is the solution to secondary fracture prevention. FLS implementation guideA step-by-step 'how to' guide to design and implement an FLS in hospitals and health systems throughout the world. FLS business planning process guideA tool intended to support clinicians and health administrators in the FLS business planning process, including a generic FLS business plan template. Multi-sector FLS coalition guideA tool intended for national osteoporosis societies and national healthcare professional organizations to establish an effective national coalition to drive widespread adoption of FLS in your country.