Long-Term Outcomes After Sepsis: Chronic Disease Management as a New Area of Focus?

AB0883-HPR CHRONIC RHEUMATIC DISEASE MANAGEMENT AND THE SELF-EFFICACY OF RHEUMATOID ARTHRITIS

BackgroundChronic disease management (CDM) is an approach to health care that keeps people as healthy as possible through the prevention, early detection and management of chronic diseases. The aim of this study was to develop interventions to improve management of chronic diseases in the form of an integrated, evidence-based chronic disease management model in Dikgale, a rural area of Limpopo Province in South Africa.MethodsA multifaceted intervention, called ‘quality circles’ (QCs) was developed to improve the quality and the management of chronic diseases in the Dikgale Health and Demographic Surveillance System (HDSS). These QCs used the findings from previous studies which formed part of the larger project in the study area, namely, the quantitative study using STEPwise survey and qualitative studies using focus group discussions and semi-structured interviews.ResultsThe findings from previous studies in Dikgale HDSS revealed that an epidemiological transition is occurring. Again, the most widely reported barriers from previous studies in this rural area were: lack of knowledge of NCDs; shortages of medication and shortages of nurses in the clinics, which results in patients having long waiting-time at clinics. Lack of training of health care providers on the management of chronic diseases and the lack of supervision by the district and provincial health managers, together with poor dissemination of guidelines, were contributing factors to the lack of knowledge of non-communicable diseases (NCDs) management among nurses and community health care workers (CHWs). Consideration of all of these findings led to the development of model which focuses on integrating nursing services, CHWs and traditional health practitioners (THPs), including a well-established clinical information system for health care providers. A novel aspect of the model is the inclusion of community ambassadors who are on treatment for NCDs and are, thus, repositories of knowledge who can serve as a bridge between health care workers and community members.ConclusionThe model developed highlights the need for health interventions that aim to control risk factors at the population level, the need for availability of NCD-trained nurses, functional equipment and medication and a need to improve the link with traditional healers.

Introduction

Objectives:We explored factors influencing Indonesian primary care pharmacists’ practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors.Methods:We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by “grounded-theory”.Results:We extracted five emergent themes/factors: pharmacists’ attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists’ inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model.Conclusion:Pharmacists’ attitudes, knowledge, skills and their working environment appeared to influence pharmacists’ contribution in chronic disease management. To develop pharmacists’ involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists’ practice in Indonesia to achieve continuity of care.

This review explored the application of chatbots in healthcare, focusing on patient monitoring, personalised care and medical services. It examined the potential of chatbots to improve patient outcomes through artificial intelligence-driven technologies, addressing challenges such as data security and system integration. This scoping review, conducted from January to March 2025, adhered to the PRISMA-ScR guidelines. A thorough literature search was performed across Web of Science, Scopus and PubMed, using keywords such as "patient care", "outcome", and "chatbot*". After screening for relevance and applying inclusion criteria, a total of 70 articles were analysed, focusing on chatbots' roles in improving patient care outcomes, data management and communication. Data charting was conducted by using a data extraction form to capture study characteristics, chatbot applications, outcomes and reported challenges. This study highlighted the surge in chatbot applications in healthcare from 2018 to 2024, focusing on 7 key themes: (1) increasing access to healthcare, (2) patient education and awareness (3) supporting clinical decision-making, (4) improving patient-healthcare professional communication, (5) chronic disease and symptom management, (6) telehealth and remote monitoring and (7) administrative support and workflow optimisation. Chatbots demonstrate significant potential to enhance patient care outcomes by improving access, communication, education and chronic disease management. Despite growing adoption of chatbots, challenges related to data security and system integration remain. Future research should focus on standardised evaluation frameworks and real-world clinical effectiveness.

The burden of chronic disease and the cost of treatment and management has skyrocketed. According to the World Health Organization (WHO), an estimated 17.9 million people died from cardiovascular diseases (CVDs) in 2016 making it the leading cause of death. Cancer is the second leading cause of death globally and was responsible for an estimated 9.6 million deaths in 2018, there are other chronic diseases which include obesity, diabetes, chronic obstructive pulmonary diseases (COPD), dementia and Alzheimer’s disease. Most chronic diseases can be caused and aggravated by physical inactivity amongst other factors. However, physical activity and exercise when properly implemented demonstrate tremendous effect in the prevention and management of several chronic diseases and health related conditions. This review focuses on the role of exercise in prevention and management of chronic diseases and the biochemical mechanism underlying it.

Context: An important component of the effective management of chronic noncommunicable disease is the assessment and management of psychosocial stress. The measurement and modulation of heart rate variability (HRV) may be valuable in this regard. Objective: To describe the measurement and physiological control of HRV; to describe the impact of psychosocial stress on cardiovascular disease, metabolic syndrome, and chronic respiratory disease, and the relationship between these diseases and changes in HRV; and to describe the influence of biofeedback and exercise on HRV and the use of HRV biofeedback in the management of chronic disease. Data Sources and Study Selection: The PubMed, Medline, and Embase databases were searched (up to August 2013). Additional articles were obtained from the reference lists of relevant articles and reviews. Articles were individually selected for further review based on the quality and focus of the study, and the population studied. Results: Heart rate variability is reduced in stress and in many chronic diseases, and may even predict the development and prognosis of some diseases. Heart rate variability can be increased with both exercise and biofeedback. Although the research on the effect of exercise is conflicting, there is evidence that aerobic training may increase HRV and cardiac vagal tone both in healthy individuals and in patients with disease. Heart rate variability biofeedback is also an effective method of increasing HRV and cardiac vagal tone, and has been shown to decrease stress and reduce the morbidity and mortality of disease. Conclusion: The assessment and management of psychosocial stress is a challenging but important component of effective comprehensive lifestyle interventions for the management of noncommunicable disease. It is, therefore, important for the sports and exercise physician to have an understanding of the therapeutic use of HRV modulation, both in the reduction of stress and in the management of chronic disease.

Objective: To explore the application effect of smart wearable devices in the management of elderly chronic diseases and their user acceptance, with a view to providing new technical support for the health management of elderly patients with chronic diseases. Methods: In this study, a randomized crossover controlled trial design was adopted, and 500 elderly chronic disease patients in Xi’an City were selected as the study subjects during the period from January 2023 to January 2024, and the study subjects were randomly divided into 250 each in the control group and the observation group. The study was divided into two phases of 8 weeks each, with a 4-week washout period in the middle. In the first phase, the control group used traditional health monitoring methods and the observation group used smartwatches with physiological monitoring functions for daily health data monitoring; in the second phase, the two groups switched roles, i.e., the control group used smart wearable devices and the observation group returned to traditional monitoring methods. Through questionnaires, interviews, and physiological data collection, the application effect and user acceptance of smart wearable devices were evaluated. The study data included patients’ physiological indicators such as heart rate, blood pressure, and sleep quality, as well as patients’ satisfaction, frequency of use, and adherence to smart wearable devices. Results: In the first stage, patients in the observation group who used smartwatches had significantly higher accuracy in heart rate, blood pressure, blood glucose, and sleep quality monitoring than those in the control group (P < 0.05). The observation group’s satisfaction score (out of 5) with the smartwatch was significantly higher than the control group’s (P < 0.05). The frequency of smart wearable device use and adherence were also significantly higher in the observation group than in the control group (P < 0.05). After the second phase of role-swapping, the original control group showed improved monitoring accuracy and adherence during the smart device use phase, whereas the original observation group showed a decrease in these indicators after returning to traditional monitoring methods, but user satisfaction and adherence remained higher than they had been in the first phase. Conclusion: Smart wearable devices have significant application effects in the management of chronic diseases in the elderly, can effectively improve patients’ health management compliance and satisfaction, and have a high degree of user acceptance. Therefore, smart wearable devices are expected to become an important tool for the health management of elderly chronic disease patients.

The bioactive peptides produced by enzymatic hydrolysis, acid hydrolysis and fermentation approach have been identified and used widely in research. These methods are important in enhancement or prevention and management of chronic diseases that are ravaging the world such as type -2-diabetes, hypertension, oxidative stress, cancer, and obesity. Sources of bioactive peptides have been established ranging from plant to animal and marine foods that have pharmacological effects; however these effects are dependent on target cells and peptides structure and conformations. Plants such as hemp and animal source such as milk among others validate the findings of In vitro and In-vivo studies and the efficiency of these bioactive peptides in the management of certain chronic diseases. This article reviews the literature on bioactive peptides with concern on food sources, production and bioactive peptides application in enhancement of health and management of hypertension, diabetes and oxidative stress. Future research efforts on bioactive peptides should be directed towards elucidating specific sequenced bioactive peptides and their molecular mechanisms, through In-vivo and In-vitro studies for specific health condition in human using nutrigenomics and peptideomic approaches.

The bioactive peptides produced by enzymatic hydrolysis, acid hydrolysis and fermentation approach have been identified and used widely in research. These methods are important in enhancement or prevention and management of chronic diseases that are ravaging the world such as type -2-diabetes, hypertension, oxidative stress, cancer, and obesity. Sources of bioactive peptides have been established ranging from plant to animal and marine foods that have pharmacological effects; however these effects are dependent on target cells and peptides structure and conformations. Plants such as hemp and animal source such as milk among others validate the findings of In vitro and In-vivo studies and the efficiency of these bioactive peptides in the management of certain chronic diseases. This article reviews the literature on bioactive peptides with concern on food sources, production and bioactive peptides application in enhancement of health and management of hypertension, diabetes and oxidative stress. Future research efforts on bioactive peptides should be directed towards elucidating specific sequenced bioactive peptides and their molecular mechanisms, through In-vivo and In-vitro studies for specific health condition in human using nutrigenomics and peptideomic approaches.

Chronic diseases such as diabetes, hypertension and cardiovascular diseases are prevalent in vulnerable populations, who often face difficulties in accessing adequate medical care. Primary care, especially family medicine, plays a central role in the prevention and control of these diseases, as it offers continuous, comprehensive and personalized care, focused on health promotion and the prevention of complications. This model of care is especially effective in communities that face economic, social and cultural barriers, allowing for early intervention and appropriate management of chronic conditions. The aim of this study is to analyze strategies for the prevention and control of chronic diseases in vulnerable populations, with a focus on family medicine. The aim is to identify effective approaches that can be used to improve the quality of life of these populations and reduce the incidence and progression of chronic diseases. The research was carried out through a qualitative literature review, focusing on articles published between 2017 and 2022. The aim was to explore the advances and challenges in the management of chronic diseases, with an emphasis on primary health practices, the impact of social determinants of health, and the role of technologies such as telemedicine in the management of these conditions. By providing continuous and comprehensive care, family medicine uses various strategies to prevent and control chronic diseases. These include regular patient follow-up, early screening for conditions such as hypertension and diabetes, and health education, which guides individuals on healthy behaviors and self-care. In addition, disease monitoring programs and interventions such as modifying eating habits and promoting physical activity have shown positive results in the management of chronic diseases. However, there are still significant challenges, such as the scarcity of resources and the lack of qualified professionals, which limit the effectiveness of these approaches in certain regions and social groups. Overcoming these barriers requires a joint effort between health professionals, managers and public policies. It is concluded that family medicine is a fundamental approach to the control and prevention of chronic diseases, especially in vulnerable populations. The strategies adopted in this model of care, such as continuous monitoring, health education and early intervention, have shown significant results in improving quality of life and reducing complications associated with chronic diseases. However, in order to optimize the results, it is necessary to overcome challenges related to access and the training of professionals, as well as ensuring adequate support for the implementation of public health programs that favour the population in situations of vulnerability. Implementing efficient public policies and expanding access to primary health care are essential to achieving effective control of chronic diseases.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease of the respiratory system characterized by airflow limitation that is not completely reversible and is associated with systemic effects especially of the cardiovascular system. COPD is frequently complicated by acute exacerbations that contribute to physical impairment and increased health care use. As COPD is a chronic lung disease with significant systemic manifestations, it is important to have chronic disease management programs specifically targeting individuals with COPD designed to improve their overall quality of life, reduce the burden of disease and decrease the impact of COPD on daily life. Chronic disease management encompasses a multidisciplinary approach designed to enhance the quality and cost-effectiveness of health care for chronic conditions and has been defined as “an approach to patient care that emphasizes coordinated, comprehensive care along the continuum of disease and across health care delivery systems”. The purpose of this present study is to evaluate the effectiveness of a chronic obstructive pulmonary disease management program implemented at the University of Louisville in 2011. Methods: We conducted a retrospective observational cohort study of COPD subjects using clinical data from medical records and cost data from a claims dataset. Respiratory health was assessed by pulmonary function testing, St. George Respiratory questionnaire, COPD Assessment Test (CAT), 6 minute walk test (6MWT), Modified Medical Research Council (mMRC) dyspnea scale, and BODE index. General measures include Duke Profile for assessing overall health and Patient Health Questionnaire (PHQ-9) for assessing depression. At baseline, chi-square test for categorical variable and t-test for continuous variable was used to check for any difference between the two groups. To check for any longitudinal significant change in quality of life measures like SGRQ, CAT score, mMRC scale, BODE index, six minute walk distance and PFT measures from baseline paired t-test was performed. For each subject, the baseline probability of participation in the disease management program was calculated by the propensity score method using logistic regression analysis. Multiple linear regression analysis was performed to assess the rate of deterioration of various clinical parameters like FEV1 and FVC between two groups. Cost analysis was done by comparing the cost related to COPD among subjects in DMP group versus those under usual care. These costs includes total COPD cost, and also sub-categories of cost like office visit cost, in-patient hospitalization (IPH) cost, out-patient hospitalization (OPH) cost, pharmacy cost, cost related to home care and laboratory cost.

The main objective of this study is to examine and highlight the substantial impact of integrating Internet of Things (IoT) technology and biosensors in the healthcare sector, focusing on their potential to drive substantial advancements and improvements in healthcare. Emphasis is placed on tackling the global challenge posed by chronic diseases by proposing an all-encompassing healthcare system that facilitates real-time monitoring, early detection, and remote management of these conditions. Chronic diseases, distinguished by their prolonged duration and gradual progression, have emerged as a marked challenge for healthcare systems worldwide. This paper seeks to illustrate how biosensors, with the capability to identify specific biomarkers, can play a pivotal role in delivering personalized patient care, enhancing outcomes, and mitigating healthcare expenses. This review was conducted using a systematic and comprehensive approach to analyze the integration of Internet of Things (IoT) technology with biosensors for real-time monitoring and early detection of chronic diseases. Relevant literature was sourced from reputable databases, including IEEE Xplore, PubMed, and Elsevier's ScienceDirect, focusing on studies published between 2014 and 2024. Keywords such as "IoT in healthcare," "biosensors for chronic diseases," and "real-time monitoring systems" guided the selection process. This review included original research articles, review papers, and case studies, which were critically analyzed to assess current advancements, challenges, and future directions in this interdisciplinary field. The findings were synthesized to provide an in-depth understanding of how IoT-enabled biosensors are transforming healthcare, particularly in chronic disease management. This research explores the integration of IoT and biosensors for real-time monitoring of chronic diseases. The combination offers personalized healthcare, early detection, and cost reduction. Applications include remote patient monitoring, cardiac health, glucose management, and elderly care. Despite challenges, ongoing advancements promise to optimize accuracy, efficiency, and ethical soundness, ushering in a patient-centric healthcare era. The integration of IoT-enabled biosensors approach to addressing global challenges posed by chronic diseases. This study highlights the potential of this convergence in healthcare by facilitating real-time monitoring, early detection, and personalized care. By surpassing limitations of traditional monitoring systems, IoT-enabled biosensors provide continuous insights into patients' health, enabling proactive interventions. Their applications are demonstrated in diverse domains, including remote monitoring, cardiac health, glucose management, and elderly care, showcasing their role in advancing precision medicine and improving patient outcomes. Despite technical hurdles, ongoing advancements in miniaturization, edge computing, and AI-driven analytics aim to enhance accuracy, efficiency, and ethical practices, paving the way for a proactive and patient-centric healthcare era.

The integration of artificial intelligence (AI) in chronic disease management is reshaping healthcare by offering personalized, predictive, and data-driven solutions for effective treatment and monitoring. This chapter explores the transformative role of AI-powered systems in managing chronic conditions such as diabetes, cardiovascular diseases, and respiratory disorders. AI-driven predictive analytics enable the early detection of disease progression, allowing for tailored interventions that improve patient outcomes and reduce healthcare costs. Machine learning models, integrated with wearable devices and real-time monitoring systems, provide clinicians with continuous, actionable insights, leading to dynamic and personalized treatment strategies. The chapter also delves into the potential of AI in optimizing drug regimens and enhancing diagnostic precision, offering a comprehensive overview of how AI is enhancing chronic disease management. Despite challenges such as data privacy concerns and the need for standardized health data, the evolution of AI technologies holds immense promise for revolutionizing personalized care in chronic disease management. This chapter underscores the importance of AI in empowering both patients and healthcare providers, ensuring timely interventions and improving the long-term quality of care.

Wearable technology in the management of chronic diseases has emerged as a significant and growing concern in healthcare. These technologies, including smartwatches, fitness trackers, and other sensor-based devices, offer continuous monitoring and real-time data collection for individuals with chronic conditions. The data collected can include vital signs, activity levels, sleep patterns, and more, providing valuable insights into a patient's health. This trend is particularly relevant in the context of chronic diseases, such as diabetes, cardiovascular conditions, and respiratory disorders, where continuous monitoring is crucial for effective management. Wearable devices empower patients to actively participate in their healthcare by facilitating self-monitoring and promoting healthy behaviors. Healthcare providers can also leverage the data generated by these devices to make informed decisions, personalize treatment plans, and intervene proactively. However, challenges exist, such as data security and privacy concerns, the accuracy of the collected information, and the need for effective integration into existing healthcare systems. Despite these challenges, the increasing adoption of wearable technology in chronic disease management reflects a promising avenue for improving patient outcomes and reducing healthcare costs through preventive and personalized care.