Introducción

Uno de los objetivos principales de OPIMEC es la creación de un glosario que pueda actuar como un lenguaje común para apoyar la identificación, selección, clasificación e implementación de prácticas innovadoras para la gestión de enfermedades crónicas. El uso de un lenguaje común permitirá establecer las características principales de cada práctica, facilitando la comparación con otras experiencias.

Este glosario colaborativo, global y vivo se encuentra relacionado con el capítulo ‘Lenguaje de la polipatología’ del libro ‘Cuando las personas viven con múltiples enfermedades crónicas: aproximación colaborativa hacia un reto global emergente’ y está inspirado en gran parte en la versión de taxonomía de Krumholz.

A continuación se muestran términos relacionados con las enfermedades crónicas complejas, desplándose en forma de árbol otros términos asociados.

1. Chronic Diseases

1.1. Individual chronic diseases

1.1.1. Cerebro-vascular Disease/Stroke

MeSH: Cerebrovascular Disorders (http://www.ncbi.nlm.nih.gov/sites/entrez) A spectrum of pathological conditions of impaired blood flow in the brain. They can involve vessels (ARTERIES; or VEINS) in the CEREBRUM, the CEREBELLUM, and the BRAIN STEM. Major categories include INTRACRANIAL ARTERIOVENOUS MALFORMATIONS; BRAIN ISCHEMIA; CEREBRAL HEMORRHAGE; and others MeSH: Stroke (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68020521&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810) Year introduced: 2008 (2000)

1.1.2. Coronary Heart Disease and Cardiac Failure

MeSH:Coronary Heart Disease (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68003324&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Pathological processes of CORONARY ARTERIES that may derive from a congenital abnormality, atherosclerotic, or non-atherosclerotic cause. Year introduced: 2008 (1987)

MeSH:Chronic Cardiac Failure (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006333&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (VENTRICULAR DYSFUNCTION), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as MYOCARDIAL INFARCTION A 

Yearintroduced: 2008 (1966) 

1.1.3. Chronic Obstructive Pulmunary Disease (COPD) and Asthma

MeSH:Chronic Obstructive Pulmonary Disease (http://www.ncbi.nlm.nih.gov/sites/entrez

 A disease of chronic diffuse irreversible airflow obstruction. Subcategories of COPD include CHRONIC BRONCHITIS and PULMONARY EMPHYSEMA

MeSH:Asthma (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68001249&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

A form of bronchial disorder associated with airway obstruction, marked by recurrent attacks of paroxysmal dyspnea, with wheezing due to spasmodic contraction of the bronchi. 

1.1.4. Dementia

MeSH:Dementia (http://www.ncbi.nlm.nih.gov/sites/entrezDb=mesh&Cmd=ShowDetailView&TermToSearch=68003704&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behaviour, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. Year introduced: 1981(1963)

1.1.5. Diabetes Mellitus

MeSH:Diabetes Mellitus http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68003920&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

A heterogeneous group of disorders characterized by HYPERGLYCEMIA and GLUCOSE INTOLERANCE.

1.1.6. HIV/AIDS

MeSH:AIDS (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68000163&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Acquired Immunodeficiency Syndrome. An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive T-lymphocyte count under 200 cells/microliter or less than14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as definedby the CDC in 1993. Year introduced: 1983.

MeSH:HIV Infections (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006678&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Includes the spectrum of human immunodeficiency virus infections that range from asymptomatic seropositivity, thru AIDS-related complex ( ARC), to acquired immunodeficiency syndrome ( AIDS). Year introduced: 1990

MeSH:HIV http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006678&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Human immunodeficiency virus. A non-taxonomic and historical term referring to any of two species, specifically HIV-1 and/or HIV-2. Prior to 1986, this was called human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV). From 1986-1990, it was an official species called HIV. Since 1991, HIV was no longer considered an official species name; the two species were designated HIV-1 and HIV-2. Year introduced: 1988

1.1.7. Musculoskeletal Diseases/Rheumatic and Osteoarticular Disorders

MeSH:Rheumatic Disease http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012216&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Disorders of connective tissue, especially the joints and related structures, characterized by inflammation,degeneration, or metabolic derangement. Year introduced: 1990

MeSH:Osteoarthritis (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68010003&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans.

MeSH:Musculoskeletal Disease

(http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68009140&ordinalpos=7&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSumRVDocSum

1.1.8. Oncology/Cancer

MeSH: Oncology http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68008495&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

A subspecialty of internal medicine concerned with the study of neoplasms.

MeSH: Neoplasms http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68008495&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms.

1.1.9. Psychiatric Disease

MeSH:Psychiatric Diseasehttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68001523&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Mental Disorder or Psychiatric illness manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. Year introduced: use pre-explosion 1974-1997

1.1.10. Renal Disease

MeSH:Chronic Kidney Failure,

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68007676&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION

1.1.11. Other Frequent Diseases

This category is reserved to diseases that have not been listed up to this point, but that have medium to high Prevalence in the population.

1.1.12. Rare Diseases

MeSH:Rare Diseases http://www.ncbi.nlm.nih.gov/sites/entrez

A large group of diseases which are characterized by a low prevalence in the population. They frequently are associated with problems in diagnosis and treatment.

1.2.Complex, Chronic Diseases (Polypathology)

A situation in which an individual is living with multiple (usually 3 or more), simultaneous, chronic and largely

incurable conditions.

1.2.1. Co-morbidity

MeSH: Comorbidity http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?mode=&term=Comorbidity&field=entry

 The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. As an example, an individual could live with multiple chronic conditions such as paralysis, incontinence, dementia and pain, all stemming from a single disease like multiple sclerosis.

Comordibity could be classified in three groups depending on the relation between the index disease and the accompanying conditions:

1. Random. These are the comorbidities that occur together with a frequency no different than the individual prevalences multiplied together, that is to say the associations occur by chance. An example in our practice is the co-existence of hand warts and osteoarthritis.
2. Consequential (classified in the literature as casual or complicated co-morbidity). These are conditions that are pathophysiologically part of the same process. it is no surprise to find that diabetes and hypertension occur together more than by chance, so these co morbidities, though interesting, are predictable.
3. Cluster co-morbidity is the non random clustering of health conditions without an evident underlying pathophysiological cause. Here is the opportunity for new discoveries - either new understandings of pathophysiology, or a new appreciation of the nature of complexity.

1.2.2. Coexisting/concurrent Diseases

The presence of multiple chronic diseases in a patient with no reference to an initial diagnosis or relationship to a

common disease. As an example, an individual could live with multiple diseases such as diabetes, osteoarthritis and early dementia.

1.2.3. Confluent morbidity

Confluent morbidity occurs when the number of chronic conditions and medications taken to control the chronic

condition prevent simple single causal identification of common symptoms such as weakness, fatigue, dizziness. In short, confluent morbidity occurs when disease manifestations and medication effects are inseparable. [10] (http://www.utoronto.ca/jcb/about/publications/bmc_hsr2005.pdf  [11] (http://www.utoronto.ca/jcb/about/publications/pbm2005.pdf0 

2. Patient Population

MeSH:Patients http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68010361&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.

2.1. Population Characteristics

MeSH:Population Characteristics http://www.ncbi.nlm.nih.gov/sites/entrez

Qualities and characterization of various types of populations within a social or geographic group, with emphasis on demography, health status, and socioeconomic factors. Year introduced: 1998

2.2. Signs and Symptoms

MeSH:Signs and Symptoms http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012816&ordinalpos=4&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. Year introduced: 1998

2.3. Risk Status

MeSH:Risk

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012306&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The probability that an event will occur. It encompasses a variety of measures of the probability of a generally unfavourable outcome. High-risk groups—such as older patients, patients with a history of prior hospitalizations, and patients with significant co morbidities—may experience fewer hospitalizations in re-sponse to disease management. Failure to account for the risk status of the target population can therefore lead to inappropriate comparisons between interventions.

2.4. Disability

MeSH:Disabled Persons

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006233&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations. 

2.5. Dependency

MeSH:Dependency http://www.ncbi.nlm.nih.gov/sites/entrez

2.6. Non clinical Characteristics

There are several aspects of people's lives that can have a profound influence on their health status and the way in which they cope with chronic conditions. These include gender, educational level, marital status, involvement in religious activities, socio-economic status, degree of perceived control over day-to-day decisions.

2.7. Events

The encounters of a person living with chronic diseases as recorded in health service databases. "High event" patients are those who have experienced three or more acute care hospitalizations as a result of their chronic illness. Those with complex, chronic conditions who have repeated hospital admissions or visits to the emergency department are also known as "frequent flyers" [12]

2.8.Registries

MeSH:Registries

http://www.ncbi.nlm.nih.gov/sites/entrez

Entry Terms: Registry, Parish Registers, Parish Register, Register, Paris,Population Register, Population Registers,Register Population The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. Year introduced: 1972(1969) - Updated lists of patients with a particular condition are also an important element of proactive chronic disease management. These registries may be developed at a practice or program level though the evolution to

population based management strategies has increased the discussion of geographic or jurisdictional registries. Suchregistries require strong policy and, in some instances, legislative frameworks. 

3. Recipient

Usually, the person who is targeted by the intervention is the same that is expected to benefit from it. For instance, a medication prescribed to a patient with high blood pressure is meant to benefit such patient. However, in other situations the intervention could target a caregiver or even a health professional, who indirectly would benefit the patient. 

3.1.Patient

MeSH:Patient http://www.ncbi.nlm.nih.gov/sites/entrez

Individuals participating in the health care system for the

purpose of receiving therapeutic, diagnostic, or preventive procedures.

3.2. Caregiver

Mesh:Caregiver http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68017028&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Persons who provide care to those who need supervision or assistance in illness or disability. They may provide the care in the home, in a hospital, or in an institution. Although caregivers include trained medical, nursing, and other health personnel, the concept also refers to parents, spouses, or other family members, friends, members of the clergy, teachers, social workers, fellow patients, etc. (see below) Year introduced: 1992

3.3. Physicians and other healthcare professionals

Frequently, the intervencion receptors are not patients, but healthcare professionals. It happens with educative or formative interventions related to chronic disease.

Mesh:   (http://www.ncbi.nlm.nih.gov/mesh/68010820?ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Invididuals licensed to practice medicine.

4. Intervention Content

MeSH:Therapy http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=81000628&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Used with diseases for therapeutic interventions except drug therapy, diet therapy, radiotherapy, and surgery, for which specific subheadings exist. The concept is also used for articles and books dealing with multiple therapies. Disease management interventions range widely from a single educational session to remote electronic monitoring to comprehensive programs involving multidisciplinary care teams. This variety reflects the perspective of those providing the intervention (e.g., physician, nurse, or pharmacist), issues specific to the patient population, and the

4.1. Drug Therapy

MeSH:Drug Therapy

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=81000188&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull

Used with disease headings for the treatment of disease by the administration of drugs, chemicals, and antibiotics. For diet therapy and radiotherapy, use specific subheadings. Excludes immunotherapy for which "therapy" is used. Year introduced: 1966 

4.2. Surgical Procedures

MeSH:Surgical Procedures http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68013514&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Operations carried out for the correction of deformities and defects, repair of injuries, and diagnosis and cure of certain diseases. Year introduced: 1998(1963) 

4.3. Complementary Therapies

MeSH:Complementary Therapies http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68000529&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice.

They may lack biomedical explanations but as they become better researched some (PHYSICAL THERAPY MODALITIES; DIET; ACUPUNCTURE) become widely accepted whereas others (humors, radium therapy) quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment. Year introduced: 2002(1986) 

4.4. Other Conventional Therapies

Procedures concerned with the remedial treatment or prevention of diseases that do not involve drugs, surgery or complementary therapies (e.g., radiation, massage, nutritional interventions)

4.5. Supportive Care

4.5.1. Palliative Care (Sympton Control)

MeSH: Palliative Care

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68010166&ordinalpos=14&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull

Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed) Year introduced: 1996 

4.5.2. Emotional and Psychological Support

Care aimed at relieving distress, anxiety, fear or any other non-physical source of suffering.

4.5.3. Informational Support

MeSH: Social Support

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012944&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull

Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities inorder that they may better cope. Informal social support is usually provided by friends, relatives, or peers, whileformal assistance is provided by churches, groups, etc. Year introduced: 1991(1983) 

4.5.4. Social Support

MeSH: Social Support

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012944&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull

Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while

formal assistance is provided by churches, groups, etc. Year introduced: 1991(1983)

4.5.5. Financial Support

MeSH: Financial Support

http://www.ncbi.nlm.nih.gov/sites/entrez

The provision of monetary resources including money or capital and credit; obtaining or furnishing money or capital for a purchase or enterprise and the funds so obtained. (From Random House Unabridged Dictionary, 2d ed.) Year introduced: 1996

4.6. Educational Intervention

An influencing force or act that occurs in order to modify a given state of affairs through the acquisition of knowledge.

4.7. Remote Monitoring

MeSH:Monitoring, Ambulatory http://www.ncbi.nlm.nih.gov/sites/entrez

The use of electronic equipment to observe or record physiologic processes while the patient undergoes normal daily activities. Refers to the measurement of physiological processes such as vital signs (heart rate, respiration, blood pressure, temperature) and other measurements (blood cells, blood chemistry, renal output, etc) at a distance using digital and analog technology.

4.8. Concordance

This term refers to an interaction between a health care provider and a person living with chronic conditions (and or their family/support person (s) whereby the implementation or use of an intervention is negotiated from the perspective of both best health evidence and outcomes, and preferences. Older related terms include compliance, adherence and joint decision-making.

4.9. Medication Therapy Management

MesH :Medication Therapy Management (http://www.ncbi.nlm.nih.gov/mesh/68054539?ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Assistance in managing and monitoring drug therapy for patients receiving treatment for cancer or chronic conditions such as asthma and diabetes, consulting with patients and their families on the proper use of medication; conducting wellness and disease prevention programs to improve public health; overseeing medication use in a variety of settings.

5. Delivery Personnel

5.1. Nurses

MeSH:Nurses

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68009726&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Professionals qualified by education at an accredited school of nursing and licensed by state law to practice nursing.

They provide services to patients requiring assistance in recovering or maintaining their physical or mental health.Year introduced: 1967(1965) 

5.2. Physicians

Physicians http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68010820&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Individuals licensed to practice medicine.

5.3. Pharmacists

Pharmacists http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68010595&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Those persons legally qualified by education and training to engage in the practice of pharmacy. Year introduced: 1968

5.4. Social Workers

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012947&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. Year introduced:1978

5.5.Registered Dietitians

Registered dietitians are uniquely trained to give advice on food, diet and nutrition. Registration within a regulatory body assures the public and employers that an individual has met the standards for academic and practical experience required for the practice of the profession of dietetics.

5.6. Occupational Therapists

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68009788&ordinalpos=6&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Personnel who work in occupational therapy, the field concerned with utilizing craft or work activities in the rehabilitation of patients. Occupational therapy can also refer to the activities themselves.

Professionals who evaluate the self-care, work and leisure skills of a person and plans and implements social and interpersonal activities to develop, restore, and/or maintain the person's ability to accomplish activities of daily living (eating, dressing, bathing) and necessary occupational tasks [13] (http://www.jimadler.com/en/legal-helpcen...

glossary-of-legal-terms.html)

5.7. Radiation Therapists

Radiotherapy http://www.ncbi.nlm.nih.gov/sites/entrez...

Individual involved in the therapeutic use of ionizing and

nonionizing radiation. It includes the use of radioisotope therapy. Year introduced: 1966

5.8. Physical Therapists (Physiotherapists)

Physical Therapy http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68026761&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The auxiliary health profession which makes use of physical therapy modalities to prevent, correct, and alleviate movement dysfunction of anatomic or physiologic origin. Year introduced: 2002

5.9. Psychologists

Psychological Techniques http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68011580&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Individuals involved in the diagnosis and treatment of behavioral, personality, and mental disorders. Year introduced: 1998

5.10. Case Managers/Care Coordinators

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68019090&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull

A traditional term for all the activities which a physician or other health care professional normally performs to insure the coordination of the medical services required by a patient. It also, when used in connection with managed care, covers all the activities of evaluating the patient, planning treatment, referral, and follow-up so that care is continuous and comprehensive and payment for the care is obtained. (From Slee & Slee, Health Care Terms, 2nd ed)Year introduced: 1996.

Individuals responsible for generating, planning, organizing, and monitoring the provision of services for patients.

5.11.Ethicists

MeSH: Ethicists (http://www.ncbi.nlm.nih.gov/sites/entrez...) Persons trained in philosophical or theological ethics who work in clinical, research, public policy, or other settings where they bring their expertise to bear on the analysis of ethical dilemmas in policies or cases. Year introduced: 2002

5.12. Massage Therapists

MeSH: Massage (http://www.ncbi.nlm.nih.gov/sites/entrez...) Professionals who perform manipulations of body tissues for the purpose of affecting the nervous and muscular systems and the general circulation.

5.13. Others involved in health Service Delivery

Individuals who do not belong to any of the above categories.

5.14. Shared Competencies

The overlap in the scope of practice of health care professionals in areas of common ability for service provision.

5.15. Peer Support

The informal assistance and encouragement provided to individuals with physical or emotional disabilities by peers

with similar ailments or interests. It may be an adjunct to self-management.

5.16. Self-management

MeSH: Self Care

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012648&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The care of oneself or one's family and friends and encompasses activities or tasks traditionally performed by professional health care providers.

6. Method of Communication

6.1. Direct (In person)

The exchange or transmission of ideas, attitudes, or beliefs among individuals or groups who are in each other's presence.

6.2. Virtual/Remote (Telehealth/Telemedicine)

MeSH:Remote Consultation http://www.ncbi.nlm.nih.gov/sites/entrez

Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. Year introduced: 1993

This category also includes telemonitoring, an approach that combines various information technologies for capturing, transmitting and analyzing physiological variables from patients with chronic conditions across long distances; and virtual communities (e.g., wikis, mailing lists, bulletin boards and other online social networks).

6.2.1.Real time or Synchronous

Real-time telehealth involves the use of information and communication technologies (e.g., a minimum set of video cameras, computer displays, and a secure high-speed Internet connection) to enable individuals to communicate live (or synchronously) over long and short distances [14] (http://cadth.ca/index.php/en/publication/788)Much simpler technologies could also be used for real-time support. For instance, the telephone can be a powerful tool to optimize

the assessment, planning, provision of information as well as support, evaluation, and documentation across long distances. (Government of the Northwest Territories Department of Health Policies and Guidelines for Community Health Nurses, Canada, 2008)

6.2.2. Store and forward or Asynchronous

Asynchronous telehealth refers to the storage of clinically important digital samples and relevant data from any location and forwarding them to a health care professional at a distant site for assessment at a convenient time [15] (http://cadth.ca/index.php/en/publication/789) . It is also known as store-and-forward telehealth. With the widespread

penetration of the Internet, the reduction in cost of data storage and the proliferation of digital cameras, patients who own Web cameras could request routine consultations with health professionals from home. Telephones with cameras are making multimedia teleconsultations possible from anywhere [16]

(http://www.cmaj.ca/cgi/content/full/171/12/1457)

7. Intensity and Complexity

7.1. Intensity

The resulting interactions of the duration, frequency and periodicity of chronic disease management interventions.

7.2. Complexity

The number of diversity of the components of chronic disease management interventions, the extent to which they relate to each other. The term also includes the degree of information exchange among patients, caregivers and health professionals (Information Complexity) [17] (http://www.utoronto.ca/jcb/about/publications/bmc_hsr2005.pdf) [18]

(http://www.utoronto.ca/jcb/about/publications/pbm2005.pdf0) , the time consumed by the interventions (Time Management Complexity) [19] (http://www.utoronto.ca/jcb/about/publications/bmc_hsr2005.pdf) [20] (http://www.utoronto.ca/jcb/about/publications/pbm2005.pdf0) , and the extent to which nuanced discussions and deliberations are required to handle the uncertainty associated with the probability of outcomes relating to diagnostic

or therapeutic interventions (Interpretive Complexity) [21] (http://www.utoronto.ca/jcb/about/publications/bmc_hsr2005.pdf) [22] (http://www.utoronto.ca/jcb/about/publications/pbm2005.pdf0) .

8. Environment

The setting in which disease management interventions are delivered also has the potential to affect both patient and financial outcomes.

8.1. Institucional/Health Facilities

MeSH:Health Facilities (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006268&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Institutions which provide medical or health-related services.

8.1.1. Primary Care Centres

Settings where integrated, accessible health care services are provided by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community [See Primary Health Care]

(http://www.ncbi.nlm.nih.gov/sites/entrez...).

8.1.2. Hospitals

Hospitals (http://www.ncbi.nlm.nih.gov/sites/entrez... TermToSearch=68006761&ordinalpos=1 itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Institutions with an organized medical staff which provide medical care to patients.

8.1.3. Long Term Care Facilities/Nursing Homes