Research Objective: In the United States (US), chronic diseases are expected to cost an estimated $42 trillion from 2016 to 2030. Government stakeholders at the local, state, and federal level are vested in helping Americans achieve and maintain health through to educate patients and providers, change behaviours and advance disease treatment. These programs could save the US up to $6.3 trillion by improving prevention and treatment of chronic conditions. Moreover, these programs may lead to increased awareness for less common chronic conditions that generally have prolonged times to diagnosis (e.g., lupus [6 years], multiple sclerosis [4-5 years]); with the goal of shorter diagnosis times, earlier disease management, and improved overall patient outcomes. In this regard, a systematic literature review (SLR) was initiated to identify US Federal, State, and local government -funded chronic disease programs to better understand their impact on clinical and economic outcomes, including disease awareness, prevention, diagnosis, costs, and patient-provider relationships and communication.
Study Design: Data sources included PubMed, Cochrane Library, and the webpages of specific public health organizations (e.g., CDC, NIH). The search included studies published between January 1, 2008 and September 27, 2018. Search terms encompassed eight chronic disease categories including autoimmune disorders, chronic lung disease, cancer, and diabetes. Outcomes themes included disease awareness, education, prevention, diagnosis, and costs. The SLR includes primary research and previously conducted systematic and targeted literature reviews.
Population Studied: Federal, State, and local government-funded chronic disease programs for adults in the US.
Principal Findings: The SLR identified a total of 54 studies evaluating programs that received government funding (n=38) or mixed funding from government and private entities (n=16). Five studies were excluded due to the studies representing an updated analysis of the same program. In total 49 studies were included in the analysis. Studies identified in the SLR were focused primarily on cancer (n=19), diabetes (n=15), and cardiovascular disease (n=8). There were no studies identified evaluating programs for autoimmune, Alzheimer’s, MS or COPD. Overall, chronic disease management programs demonstrated positive outcomes across patient populations, disease areas, and outcomes.
Conclusions: The SLR demonstrated that government-funded programs have a positive impact on disease awareness, screenings, and outcomes. Lifestyle management programs appeared to be the most successful in improving outcomes, health behaviour modification and education programs; while programs focused on patient/provider relationships also demonstrated improved awareness and appropriate use of health care resources. There is a need to better understand government-funded programs in other chronic conditions, particularly more challenging to diagnose conditions where awareness and understanding may be critical for appropriate diagnosis.
Implications for Policy or Practice: While it is logical that government-funded programs are focused primarily on more widespread chronic conditions such as diabetes and cardiovascular disease, future policies and funding decisions should consider chronic diseases which are less understood by both patients and providers and lack definitive diagnostic criteria. Increasing awareness, changing health behaviours, and improving patient/provider relationships could be critical in improving patient outcomes and appropriate use of health care resources in these less common chronic conditions.
