Health Care Professional's Guide to Disease Management, The

American Journal of Pharmaceutical Education, Summer 1999 by Francisco, George E

JAMES B. COUCH. The Health Care Professional's Guide to Disease Management. Gaithersburg MD: An Aspen Publication, 1998. xvii 345 pp., 60 figs., 11 tbls. $49.00.

Caveat emptor: This is not a book of disease management protocols. It is not a reference text for practitioners. It is not really a guide to disease management and would not be of interest to many health care professionals. It is, however, an excellent discussion of "disease management"-what it is, how health care has evolved to embrace this concept, and why health professionals should continue to pursue and develop this type of patient-centered care.

The editor of the book and author of the first chapter is a corporate physician-attorney who has keen insight into health care in the United State from a provider's, marketer's, and payor's perspectives. The book consists of twelve chapters, written by physicians, public health professionals, a nurse, and a pharmacist. The first half of the book examines various components of disease management such as the stakeholders, the need for disease management from a public health perspective, the need for a standardized knowledge base and set of practice guidelines to achieve desired outcomes, and clinical outcomes measurement and management. The final six chapters focus on the current application of disease management principles within managed care organizations, the pharmaceutical industry, employer-purchaser groups, health professionals, and patients.

The authors agree that disease management is a patient-centered process of providing high quality health care. The process consists of creating a knowledge base, setting goals, developing risk stratification and intervention planning, communicating interventions, modifying behavior, redesigning the environment, and measuring outcomes. The stakeholders in the process include purchasers, payers, providers, practitioners, policy makers, product producers, and patients. According to the authors, the primary obstacles to overcome include information technology and management shortfalls, practitioner resistance, and impatience. The vast majority of the text is centered around explaining each of these issues and defining roles of the stakeholders. Very little attention is given to existing models that actually work, and as a result, the reader comes away with many more questions than answers.

While very thorough and informative, the chapters are sometimes tedious to read. Consequently, the book has limited use as a text for pharmacy students or as a reference text for practitioners. It would be a useful text in a graduate course that focuses on the U.S. health care system and trends toward patient-oriented outcomes.

George E. Francisco

University of Georgia