Solutions to the problems of chronic disease management in rural settings

Recent changes in disease patterns in the United States from acute to chronic disorders and the maldistribution of medical manpower have disproportionately affected rural residents. Programmatic attempts to alter the medical care system in rural areas have traditionally centered on increasing the number of primary providers. In central Mississippi, two innovative alternative models of chronic disease management have been evaluated. The disease focus was high blood pressure and the two management models emphasized: the use of local residents as health facilitators or health counselors, and the use of self-help groups in family and church settings. Eighteen months of outcome data indicated that the health facilitator model was controlling 80 percent of the hypertensives participating; the family-based self-help groups were controlling 90 percent; and, the church-based self-help groups were controlling 79.9 percent. These community-based models of chronic disease management have broad implications for other geographic areas and other chronic disorders.