APH 2003, 61, 161-176:

Is everyone with a chronic disease also chronically ill ?

J. De Lepeleire, J. Heyrman

Keywords: Chronic disease, social security

Caring for chronic patients is a major challenge for society in the Western world. All governments are introducing measures to benefit chronic patients. The question here is: what are chronic diseases and who is chronically ill?

A chronic disease in general practice is an episode of treatment for a defined disease that extends over a long period and is so serious that without treatment "ordinary" everyday activities for the patients age and sex will be hindered by it to a significant extent and over a long period. The term "chronic" does not say anything about the seriousness of the condition or the stage of disease that has been reached: the patient might have diabetes mellitus which is effectively controlled by oral antidiabetics.

A chronic patient is a person with a chronic disease which has a major impact on the everyday activities which are normal for his/her age and sex.

There are a number of important principles when it comes to taking measures and making decisions. 1. A positive approach must be taken to the care situation. The starting point should be self-reliance, not the need for care. The new International Classification of Functioning from the World Health Organisation is a useful starting point for this purpose. 2. Clear goals must be established. 3. These must be linked to the real need for care. 4. All this must be assessed on a multidisciplinary basis. 5. Re-evaluation over a period of time is necessary.