Table 2.
Individualized stepped care: a scheme for managing chronic illness in primary care
| Acute (episodic) care | MANAGEMENT CONTINUUM | Chronic care | ||
|---|---|---|---|---|
| Goals | • Control disease | EVIDENCE-BASED PROTOCOLS GUIDING CLINICAL MANAGEMENT AND LEVEL OF CARE | • Prevent complications | GOALS |
| • Decrease symptoms | • Prevent relapse | |||
| • Prevent disability | • Minimize disability | |||
| • Prevent chronicity | ||||
| Level 1 | • Recognition and diagnosis with screening and diagnostic tools | FOR ALL PATIENTS AT EACH STEP | • Monitoring patient status to guide long-term management | Level 1 |
| • Watchful waiting with active follow-up for subthreshold illness |
Collaborative Management: Shared problem definition, goal setting and care plan + Self-management training & support + Active following-up
|
• Preventive care | ||
| Level 2 | • Treatment by the primary care physician | • Self-management with low-intensity support | Level 2 | |
| Level 3 | • Speciality consultation in support of primary care management | • Lower intensity car management services | Level 3 | |
| Level 4
|
• Referral to specialty setting for more complex or intensive intervention and/or to refine care plan
|
• Higher intensity care management services
|
Level 4
|
|
| Figure adapted from Tiemens.45 | ||||