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Multidisciplinary Approach to Obesity Management: A Case Report

Multidisciplinary Approach to Obesity Management: A Case Report

Published on: May 30, 2025

Collaborative management of chronic illness

M Von Korff¹, J Gruman, J Schaefer

¹Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101, USA.

Annals of Internal Medicine

|December 31, 1997

Summary

Collaborative management enhances chronic illness self-care by involving patients and families in problem definition, goal setting, training, and follow-up. This approach supports patients in managing their health effectively.

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Area of Science:

Health Services Research
Chronic Disease Management
Behavioral Medicine

Background:

Chronic illness places significant care burdens on patients and families.
Effective patient-provider collaboration is crucial for successful self-care.
Collaborative management aims to strengthen self-care and ensure comprehensive health interventions.

Purpose of the Study:

To outline essential elements of collaborative management for chronic illness care.
To present a framework for enhancing patient and family self-care capabilities.
To emphasize a unified approach to chronic illness management.

Main Methods:

Discussion of four key elements of collaborative management.
Emphasis on behavioral principles and empirical evidence.
Integration of patient-defined and medical problems.

Main Results:

Collaborative problem definition includes patient-identified issues.
Goal setting and planning align with patient preferences and readiness.
A continuum of self-management training and support is established.
Active and sustained follow-up monitors health status and reinforces care plans.

Conclusions:

Collaborative management provides a core set of services for chronic illness.
This model supports patients and families in handling self-care tasks.
The framework is adaptable across different chronic diseases.