Background and context
In diabetes care, as in care for other chronic diseases, this definition of agency is of particular importance because patients are responsible for their own care on a daily basis. Diabetes, which affects the way the body uses digested food for growth and energy, is managed through a daily self-maintenance regime that includes controlling blood sugar levels, weight, blood pressure, and cholesterol. Since diabetes became a chronic condition treatment has focused on educating patients on self-care strategies outside of the medical encounter. Patients learn the proper way to test their blood and inject insulin or take medications; they learn what “good” numbers are versus “bad” ones; and they learn how to correct for bad numbers using an intricate balancing act of food, exercise, and medication.
To perform such tasks, the agent/patient must be persuaded to engage in these acts, or ‘comply,’ if we use the language of the traditional diabetes care delivery model. Compliance, the model of care used for diabetes treatment since insulin was developed in the 1930s, is defined as “the extent to which an individual patient’s behavior follows the treatment regimes recommended by his health care providers”(Lutfey & Wishner, 1999). This model grew out of the acute care model, which focuses on the treatment of a disease for a short period of time for a brief but severe episode of illness (Anderson & Funnell, 2000). While the paternalistic nature of this model has been acknowledged (Trostle, 1988), it remained a mainstay of the medical community’s approach to diabetes (Stone, 1997) over the last several decades. As disease prevalence and incidence rates (as well as costs) continue to rise, however, the effectiveness of this approach was questioned and the medical and health communities moved to explore other models. The Chronic Care Model (CCM) is the most pervasive of these.
Unlike the compliance model, the CCM (shown above) is based on the assumption that improvement in care requires patient, provider, and system-level interventions. It has six distinct components: organizational support, clinical information systems, delivery system design, decision support, self-management support, and community resources.