75 One practical way is to draw on the experience of patients from similar backgrounds who are already successful in managing their disease using, for example, the methodologies of positive deviance.76,77 The impact of

the disease on the family cannot be overestimated in coping with new roles, and there may be the problem of impotence affecting sexuality. Obviously there are financial issues, especially if the patient Inhibitors,research,lifescience,medical is poorly insured and unable to continue his/her work. Evidence from chronically ill populations, including diabetes, shows that improved outcomes occur when care systems shift from acute to chronic care paradigms, particularly if they include support for patient self-management.78–84 The new approach requires moving from predominantly acute-care-driven management plans which generally ignore behavioral, psycho-social, and environmental factors, towards models that guarantee effective long-term illness care. These should combine the following features: (1) provide comprehensive, multidisciplinary Inhibitors,research,lifescience,medical care, (2) integrate and co-ordinate care along the care Inhibitors,research,lifescience,medical GSK1349572 continuum, (3) be disease or population-specific, (4) include

tools to promote patient self-management, (5) be evidence-based, and (6) imbed information technology.78,80,85,86 There is also good evidence that adherence improves diabetic control87 thereby delaying complications.88,89 The challenge for health

teams lies in promoting this goal, the economic consequences of which are obvious.90,91 Given that clinical results depend principally on patients’ daily self-management, Inhibitors,research,lifescience,medical tackling non-medical risk factors through interventions to support it sociotypically represents a potentially powerful pathway to improve long-term outcomes Inhibitors,research,lifescience,medical in the chronically ill. MANAGING THE PATIENT WITH CHRONIC DISEASE For any given patient, the ability to cope with chronic disease is dependent on elements in the three sociotypic domains which, in turn and to varying degrees, determine the long-term outcome. Phosphoprotein phosphatase The lists of factors in Tables 1 and ​and22 suggest that conventional medical education does not yet prepare future practitioners for such a task. It is difficult to envisage all the skills required since they are multidisciplinary, involving, in addition to medicine, the integration of the sciences of sociology, psychology, and anthropology inter alia. Systems biology has been proposed as the new direction, but the initial versions of it are still too bio-reductionist to encompass the necessary sociotypic elements.1,92,93 In order to assess patients with chronic diseases, the medical history has to be expanded to include consideration of the sociotype. This is much more than the conventional social history of living conditions and socio-economic circumstances.