Collaborative Care for Patients With Depression and Chronic Illnesses, Essay Example

Community Assessment and Nursing Plan

Winterlane, Maryland faces a number of common yet critical health challenges that impact its population in different ways. It is important to specifically identify these concerns and to take the steps that are necessary to accomplish the intended objectives, while also considering other means of supporting high quality patient care and treatment throughout this community. Some of its members face significant health disparities that must also be addressed and require nurses’ expertise, guidance, and input in order to accomplish the desired objectives. Local efforts must identify areas of the greatest need and aim to provide patients with the tools and resources that are required to achieve successful results and the creation of a community-based environment that supports improved health and wellbeing for its members through outreach, education, and direct care and treatment for its members. The following discussion will address the role of chronic disease in the Winterlane community and its impact on overall health and will evaluate the factors that are associated with the identification health disparities within this population in order to achieve the desired outcomes and quality of life for local residents.

Windshield Survey

The community of Winterlane, Maryland faces a number of important health-related concerns that require an in-depth analysis and evaluation in order to improve outcomes for local residents. This community, which is located in Baltimore County and is in close proximity to Baltimore proper, represents its local residents and their diverse health needs in different ways, while also supporting the future direction and scope of healthcare practice within this area. For local residents, there are a number of factors that must be considered when evaluating the community and its current overall status, given the common concerns that many communities face that have an impact on their health and general wellbeing. Winterlane is fortunate in that it possesses a number of health-related resources, including a large and well-established psychiatric hospital. However, health disparities within the community remain an issue that must be addressed effectively through interventions and other strategies that will support the ability of this population to receive healthcare services in the desired manner.

In general, Winterlane suffers from a lack of economic stability within its population, whereby many local residents possess difficult economic challenges and other limitations that have had a negative impact on their overall wellbeing. This has been a very difficult and lasting issue for many residents, some of whom are at the poverty level or are on the brink of poverty and are unable to secure the resources that are required to address quality of life concerns effectively. Therefore, local residents face a number of critical issues that require further consideration, particularly as they strive to improve their lives and to overcome adversity as best as possible. These efforts require local organizations who serve community members to examine the economic conditions that exist and to recognize where disparities are evident so that there are opportunities to examine new ideas to improve quality of life from a variety of perspectives.

The diversity of the local population in Winterlane must be considered as a contributing factor in understanding the community dynamic and the communication that exists among local residents. This diversity offers a number of positive opportunities, but it also contributes to a threat of violence and other issues due to dangerous conditions within some areas, including those related to gang involvement. Therefore, many local residents experience a heightened sense of anxiety and stress out of fear for themselves and for their homes and families. An evaluation of the local community supports this level of apprehension, particularly since there is a high level of discomfort in traveling along some streets, due to fears of violence and other issues. Therefore, it is not surprising that the community faces a number of serious risks that must be addressed in consideration of addressing specific health issues that impact local residents in different ways.

In spite of the negative issues that exist within the community with respect to the economic climate and fears regarding safety, the community possesses a rather large faith-based coalition and supports a high degree of diversity within the religious sector. In addition, there is an opportunity to expand personal strengths with a skills center that is designed to promote growth among members of different population groups. This center also supports the development of programs that are specifically designed to reduce street violence and to keep children and teens off the streets as best as possible to prevent further risk or harm. This process is important because it explores the different areas where Winterlane requires continuous improvement in order to thrive and to be successful in its efforts to overcome adversity and other challenges that impact its residents.

The windshield survey for Winterlane is an important step in identifying a number of current and emerging health issues and concerns that impact local residents and that influence the community and its people in different ways. Across all age groups, from young children to older adults, there are disparities within the Winterlane community that exist that play a role in advancing perspectives regarding the needs of this area, using existing data and resources as a guide in framing the community’s overall health status. Health resource utilization is mixed within the community and appears to be severely underutilized by some local residents within different population groups. Furthermore, in spite of a large mental health facility within the community, there appears to be a significant set of challenges related to mental health that is a concern for local residents in many ways. Therefore, it is important to determine how Winterlane might benefit from new strategies and improvements across the healthcare spectrum in order to accomplish the intended objectives and areas where growth and improvements in health and wellbeing may be possible.

The windshield survey that was established for the Winterlane community offers a summary of existing health concerns and areas where improvements are likely to occur to advance the community and its quality of life. Therefore, an examination of the different areas where health issues are evident must be identified in order to establish a strategy that will improve outcomes for local residents in different ways. It is necessary to determine the impact of different health concerns for local community residents and to identify areas where progress might be made in developing strategies to improve health and wellbeing. In addition, it is important to identify the different areas whereby there are significant opportunities to expand access to healthcare services and to be proactive in supporting an agenda that includes improvements in healthcare utilization across different population groups.

Key informant interview questions and responses.         

An examination of a sample of local residents living in Winterlane requires an evaluation of the different areas that demonstrate the level of diversity and strength within the community, along with an identification of the weaknesses and challenges that persist within the area. In order to better understand the dynamics within the local community, two interviews were conducted with residents who are active in the city, including a police officer and a registered nurse. These professionals are integral members of the community and were able to provide a unique perspective regarding the city that others might not have. These contributions play a role in shaping the community and in supporting the development of new perspectives to determine the overall status of local residents.

From the perspective of the police officer, it was clear that crime is frequent in Winterlane and creates much tension, stress, anxiety, and apprehension among local residents regarding their wellbeing. The police officer possesses numerous concerns regarding gangs and related violence, general threats of violence, and overall poor economic conditions within the city. This is a difficult set of circumstances to address because it has an important impact on health status for many residents. The police officer has become increasingly aware of the fear that many residents face in regards to their safety; therefore, additional resources must be allocated to address these fears as best as possible. The police department is well aware of the risk of violence and crime within Winterlane; as a result, they have been working tirelessly to create programs and to monitor local conditions in order to improve the safety and security of local residents as best as possible. This has been a positive step towards a greater sense of discovery and in identifying the needs of local residents through the actions taken by law enforcement to alleviate some of these fears. However, many problems remain, even for those who do not experience economic turmoil; therefore, these issues must be addressed as effectively as possible in order to improve the lives of all local residents.

The interview with the registered nurse supported many of the same sentiments and the challenges related to living in Winterlane in a tumultuous environment.  Her perspectives advanced the belief that Winterlane faces a very difficult state because of its highly rundown streets and neighborhoods. This is an important reminder of the difficulties related to sustaining a positive living environment when resources are limited and control is lost over many characteristics of the community and its people. The nurse also fears for her safety and that of her neighbors in many ways, and this reflects the importance of developing a strategy to overcome some of these conditions and to make it safer and more comfortable for local residents. The nurse reiterated many of the same sentiments regarding the community that the police officer shared, but also went a step further to discuss the health status of the local population and the issues that they face. Most importantly, the nurse noted a variety of imminent concerns including extreme obesity, poor diet, limited exercise, diabetes, high blood pressure, and heart disease, among others. From her perspective, the nurse found it difficult to accept these conditions and how they have impacted local residents. As a result, these problems must be addressed in an efficient and time-sensitive manner in order to prevent further complications and other issues from taking place that could have an even more difficult influence on residents in different ways.

Health-based problems and nursing diagnoses.

• One of the critical issues that was identified in the windshield survey was the lack of consistency in utilizing available healthcare resources within the community setting. As a whole, Winterlane is not lacking in healthcare resources; therefore, it must continue to be reflective of the opportunities that are available to explore healthcare options more effectively. In this context, many residents may either lack health insurance altogether or may lack access to specific services, thereby rendering their insurance incomplete. Under these conditions, community residents may lack the resources that are necessary to visit a physician on a regular basis and to be proactive in taking charge of their own health. This is an important reminder that Winterlane faces critical concerns that require further consideration and evaluation in order to achieve the intended outcomes and to improve access to care for local residents.
• In order to accomplish the desired objectives, it is important to understand how access to healthcare or lack thereof plays a critical role in shaping patient care outcomes and expectations, and how these factors contribute to the overall direction of care and treatment that are likely to benefit local residents the most. Therefore, a patient-centered approach to patient care is essential so that nurses are able to accomplish their key objectives in administering care and treatment to all patients in a timely manner. It is believed that “For a conceptual framework for access to facilitate improvements in care, it must be applied to a healthcare system that has the capacity to adapt itself to accommodate the characteristics of individuals that result in poor access to care such as poverty, poor health literacy, and rural residence” (Fortney, Burgess, Bosworth, Booth, & Kaboli, 2011). This will demonstrate the importance of developing a framework that will capture the essence of nursing care and delivery through a patient-centered approach to diagnose patients effectively and in a timely manner, along with the creation of an environment whereby nurses are able to administer care and treatment on a continuous basis through improved access to these services over time to accommodate patients as best as possible (Fortney et.al, 2011).
• Many residents residing in Winterlane face a number of critical concerns associated with a high risk of chronic disease. Due to the prevalence of obesity, there is also an associated risk of chronic diseases such as diabetes and hypertension, along with a higher risk of heart disease and stroke for many residents. As a result, it is important to identify areas where education is lacking for local residents and how this issue might be alleviated through expanded educational opportunities for residents. This will ensure that they possess the knowledge that is required to improve their health through positive decision-making in regards to making healthier choices in their lives, including improved nutrition and increased physical activity. This is a significant need within the community that requires urgent attention and focus in order to accomplish healthier results and improved quality of life.
• Nurses must be able to effectively identify the risks associated with chronic disease and a number of population groups who face these risks, including older adults. Nurses must be able to examine patients in a concise manner and be able to identify any possible health concerns within different populations. In addition, there is a significant need for nurses to be fully involved in the prevention and management of chronic disease in patients, along with other factors that play a significant role in shaping patient care outcomes for this population and others who face a similar risk. At the same time, nurses must be able to fully and concisely diagnose patients so there are improvement is healthcare practice and the development of new strategies for growth to accommodate patients and their needs as effectively as possible (Hung et.al, 2011. Most importantly, nurses must be able to identify health conditions that require further treatment in order to reduce the risks associated with symptoms and other complications that may impact patient care outcomes in a negative manner (Hung et.al, 2011).
• Within this community, there appears to be a significant lack of access or utilization of preventive care services for many residents across different population groups. Therefore, it is likely that many residents suffer from a lack of preventive services and screenings for such diseases as diabetes and high blood pressure, along with a lack of vaccinations and routine testing to identify possible health concerns that may require additional attention and focus. It is important to identify the resources that are lacking and to aim to fill this void through the development of new strategies to improve access to preventive care services and to meet other needs effectively and without delays that could impact quality over time. Therefore, interventions are required as a means of developing a strategy for improving access to preventive care services and other emerging needs that may impact quality of life in different ways.
• Preventive care appears to be a critical issue for many people within the Winterlane community; therefore, this problem requires a significant nurse-led approach that will recognize its extent and the ability to effectively overcome the challenges that are related to patient care and treatment, along with other factors that will positively impact patient outcomes and promote an increased use of these services within the community. The issue of preventive care continues to be a serious problem in many communities such as Winterlane; therefore, it must be addressed by nurses in a manner that is consistent with local objectives and other concerns that will have a lasting impact on patient care and treatment in many ways.

Nursing plan.

The development of a successful nursing plan to accommodate the most critical needs of the Winterlane community requires a high level understanding and acceptance of the different areas where nurses might play a critical role in shaping healthcare outcomes and in supporting the demand for new types of services that will improve quality of life. For example, the role of nurses in the management of chronic disease must be addressed in order to accomplish the intended objectives to prevent these diseases and/or to treat them effectively in order to minimize complications and other concerns for this patient population. These factors will also demonstrate the importance of developing a nurse-led effort or intervention to facilitate improve quality of life and to address the overall needs of residents within the Winterlane community over the long term. With preventive care as an outstanding issue within this community, this requires a high level understanding and acceptance of the different areas whereby patient care is improved through the expansion of preventive care and delivery within this community.

There are many ways in which nurses might effectively contribute to the management of chronic disease within the patient population. For example, this process reflects the importance of identifying populations with the greatest level of need and determining how to overcome adversity to address potentially serious health concerns within this population. These factors require nurses within the community to evaluate their options and to be effective communicators in supporting a change environment that will have a lasting impact on local residents. In addition, it must demonstrate the importance of evaluating patients effectively and continuously over periods of time to support change and progress within the community in this manner.

Nurses must play an active role in addressing the challenges of chronic disease prevention and management within the Winterlane community, and this may be accomplished by adopting a set of principles that are likely to be effective in supporting an advanced agenda and level of strength in supporting effective patient care outcomes for local residents who require treatment and/or prevention services in one form or another. Nurses must be able to effectively adapt to changes within the population makeup of the community and aim to be proactive in meeting patient care needs through their activities that are administered within the healthcare setting, while also recognizing that their work is highly valued and necessary to improve the overall health and wellbeing of the population as a whole.

Some experts also classify mental illness in some capacities as a chronic illness; therefore, this issue must also be considered as part of a larger framework to achieve greater success and opportunity within the industry that will support effective patient care and treatment in a desirable manner to overcome challenges that may be debilitating on many levels for many patients (Edward, 2013). To be specific, self-care is a critical factor in the ability to manage disease effectively and to be proactive in meeting patient care needs without delays, while also demonstrating a level of potential resiliency that may impact patients in a positive manner (Edward, 2013). Managing self-care represents an opportunity to examine the different areas whereby patients are able to gain some degree of self-confidence and the ability to be effective in administering self-care effectively and consistently (Edward, 2013). From this perspective, it may be argued that nurses must be active facilitators of change at the self-care level in order to empower patients with one or more chronic diseases to be effective in caring for themselves when not under the direct supervision of a nurse or physician (Edward, 2013). In addition, this practice enables nurses to provide patients with much-needed guidance and support so that they are able to effectively share their knowledge and resources with patients to improve quality of life and strength in this dimension.

For the residents of Baltimore, Maryland to include the Winterlane community, it is important to identify the specific areas whereby there are opportunities to improve education to reduce the prevalence of chronic disease in many areas. The primary causes of death within this area include heart disease, cancer, stroke, chronic obstructive pulmonary disease, accidents, and diabetes in that order (Maryland Department of Health and Mental Hygiene, 2011). Within this area, there is an upwards trend in the prevalence of obesity within local residents, and this has a lasting impact on patient care and the risk of chronic disease (MDHMH, 2011). Furthermore, the cost of managing chronic disease is very high, with $84 of every $100 spent used to treat chronic disease as of 2006, and per capita healthcare spending for Maryland residents was $5,590 in 2004, which ranked 17^th on a national level (MDHMH, 2011). These statistics indicate that the trend towards obesity continues to increase and requires further analysis and consideration in order to accomplish the intended objectives and to treat patients to accommodate a high level of need and a focus on chronic disease, particularly in Winterlane. Based upon these statistics and other key characteristics for the Winterlane population, nurses must expand their roles in addressing the prevention, care, and treatment of chronic disease in order to accomplish improvements in health and wellbeing within the local population, while also considering other areas where nurses might be able to actively contribute to achieve successful results for this patient population.

For the problem of chronic disease management, nurses must assume a highly active role in this process that includes the creation of an environment in which patients have greater access to the services that will support improvements in their health and wellbeing on a gradual basis. Therefore, a number of primary nursing interventions must be identified that will be effective in addressing specific patient care needs associated with chronic disease and the ability to minimize risk as best as possible. For example, the use of educational programs with disadvantaged members of the population serves as a positive step in addressing the needs of local patients and in determining their level of knowledge and understanding of chronic disease and their own individual levels of risk within the community. This process also requires nurses to exercise a high degree of knowledge and support for disadvantaged persons so that they possess a greater awareness of their own risks of chronic disease and what is required to educate the public regarding serious health concerns such as diabetes, hypertension, and heart disease (Taggart et.al, 2012). It is known that “the benefits of high levels of health literacy include improved preventive care and early detection of illness and disease, ability to access the most appropriate form of health care and management of chronic disease” (Taggart et.al, 2012, p. 2). In this context, nurses must identify areas where they possess strength and knowledge that will aid local residents in preventing or treating chronic diseases effectively and consistently (Taggart et.al, 2012).

Another primary intervention for nurses is to utilize screening tools actively and as early as possible in order to address chronic disease risk before symptoms arise and permanent damage to organs and systems has been sustained. Screening tools for a host of chronic diseases are readily available in many communities, yet they are not always taken advantage of at the desired level to promote improved health and wellbeing (Howard et.al, 2010). These screening tools may have a positive and lasting impact on patients when they are used effectively to evaluate risk and to determine when there is existing evidence of chronic disease (Howard et.al, 2010). This practice must support the continued growth and expansion of chronic disease in a manner that is consistent with a need to expand resources and to promote inclusion among local residents who face a variety of health risks related to chronic disease (Howard et.al, 2010).

Finally, a primary prevention tool for nurses to administer to patients in the local community is through outreach in the community setting, using clinics and pharmacies as a primary tool to promote advancing practice nursing and improved direct contact with patients in the clinic environment. This is an important reminder of the different areas in which patients require further evaluation in order to achieve the intended outcomes. Patients face a high degree of risk when they are classified as part of a disadvantaged population; therefore, they require a high level of support and acknowledgement by nurses in both traditional and non-traditional settings in order to obtain the proper assessment and evaluation that is necessary to screen for and treat diseases effectively. This practice will encourage nurses to actively contribute to the evaluation of local residents for chronic diseases that impact their health in different ways. This is an important step towards the discovery of a balance that will identify those members of the population with the highest level of need, while also considering the role of nurses in facilitating health-related changes that will positively impact residents over time.

Secondary interventions may also be identified that will have an important impact on the residents of Winterlane, particularly as nurses identify areas that require further evaluation and improvement among this population. For patients who have been diagnosed with one or more chronic diseases in the past, there is an important opportunity available to examine the different areas of the disease(s) and its impact on their lives, from past and current symptoms to any treatments that are underway. These criteria represent a means of understanding the different risks that are associated with treating the chronic disease and how it has impacted the patient to date. Therefore, nurses must be involved in the evaluation process by examining patients, taking vital signs, and asking questions regarding any symptoms that are evident in order to establish an understanding of the extent of the condition within each patient and how it has impacted his or her quality of life.

Another secondary intervention that requires nurses’ input is to ensure that patients who have been diagnosed with a chronic illness and have been prescribed medication are taking their medications according to the recommendations set forth by the physician or the nurse practitioner. This is an important necessity for patients who are facing chronic diseases that require ongoing treatment to minimize symptoms and other concerns. In this context, nurses must play a significant role in shaping outcomes over the short and long term for these patients by promoting medication adherence on a continuous basis (Roebuck, Liberman, Gemmill-Toyama, & Brennan, 2011). These patients are likely to experience improved health status over time when they are able to effectively administer medications without difficulty, and it also enables them to be proactive in taking charge of their own health circumstances (Roebuck et.al, 2011). Under these conditions, it is important to recognize the value of developing a strategy for nurses to follow that supports medication adherence for patients with one or more chronic diseases as a means of alleviating symptoms and reducing the risks associated with long-term damage that may be sustained as a result of a chronic illness (Roebuck et.al, 2011).

A final secondary intervention that may be helpful for patients is to examine if the prevalence of chronic disease has impacted quality of life in one form or another and to recognize the value of developing a strategy to improve quality of life through activities of daily living, which may also include work and educational responsibilities. Patients who have one or multiple chronic diseases may not feel well much of the time or may not have the energy to achieve optimal quality of life due to symptoms and other impacts of the disease; therefore, these issues must be considered in a larger context that will have a lasting impact on outcomes and on the creation of an environment that is supported by nurses to achieve a greater sense of normalcy and satisfaction with the quality of life. This is an important and meaningful step for nurses to take in supporting the needs of their patients over time and as one or more chronic diseases progress to the next level. The purpose of nurses in this capacity is to minimize the expansion of symptoms and the reduction of quality of life through the creation of an environment that embraces change and progress and that supports the demand for new types of interventions or treatments that will enable patients to achieve the much-desired level of normalcy that is necessary to achieve greater quality of life.

A number of tertiary interventions using a nursing-based approach are also available for consideration because they identify specific areas whereby patients are able to maintain a greater semblance of quality within their lives, rather than to succumb to the symptoms that they are experiencing with the evolution of chronic disease. One tertiary prevention mechanism from which nurses might benefit is the development of a program plan to address rehabilitation in the event that chronic disease has caused significant harm to organs or systems and for which there has been a reduction in quality of life.  With these interventions, nurses must examine their roles in working with patients and in determining how to best approach them to have the greatest possible impact through an organized intervention in this capacity. It is anticipated that nurses will lead rehabilitation efforts for patients so that they are able to effectively manage their needs in an organized fashion. Most importantly, nurses will provide specific instructions to patients and strive to be effective communicators of a rehabilitation or recovery strategy that is instrumental to a patient’s recovery and improved quality of life. These processes will ensure that patients receive as much attention and focus as possible during the rehabilitation stage in order to alleviate further symptoms and possible decline. This is an important and meaningful step towards the discovery of a strategy that will encompass new ideas to enable nurses to provide expert knowledge and guidance to patients at all times to improve their overall health and wellbeing.

Another possible tertiary intervention that may be useful from a nursing perspective is the development of a successful strategy that will encompass effective outcomes for patients through specific programs designed to target symptom management, including but not limited to pain, blood pressure regulation, and/or blood glucose management. These factors will demonstrate the importance of developin to ensure that g a strategy in which nurses either administer blood pressure or glucose testing themselves, or provide training and education to patients in order to administer self-care in the home environment. These efforts require nurses to communicate with patients regarding these needs and to be effective in supporting their ability to perform effective self-care in the home environment that will be used to monitor any possible changes in a chronic health condition that may impact symptom formation or alleviation. This process is important in enabling nurses to fully interact with patients and to be proactive in meeting the needs of patients effectively and efficiently without delays or other issues that could impact patient care and treatment in any way. The ability to educate patients regarding self-care activities is essential to their growth and their ability to manage chronic diseases effectively and consistently. This practice requires a greater understanding and acknowledgement of nurses’ knowledge and experience in this area and how it is conveyed to patients so that they are able to perform self-care effectively and consistently at all times. These efforts are particularly significant if patients possess other complications that may exacerbate their chronic disease status, such as depression that may contribute to the worsening of some symptoms (Ludman et.al, 2013). In addition, this process requires an understanding of the different elements that support self-care and a greater level of independence for this group of patients (Ludman et.al, 2013). Under these circumstances, it is necessary to evaluate the conditions under which patients might benefit from the administration of self-care activities to accommodate patients in need and to also consider how collaborative care plays an important role in improving health and wellbeing in the wake of chronic disease (Katon et.al, 2010).

Finally, the role of self-care and ongoing support by nurses must also be examined more closely and provide a greater sense of the process and why it is essential to the patient care process on a regular basis. This process requires nurses to explore their options through possible interventions to support patients who must perform self-care activities at home and who require other needs (Ludman et.al, 2013). In this capacity, nurses must be able to demonstrate their ability to work with and provide ongoing support to patients in order to prevent further and unnecessary complications of disease that could otherwise be prevented through the support and encouragement that nurses provide (Ludman et.al, 2013).

Conclusion

The residents of Winterlane, Maryland face a number of critical health concerns that require further evaluation, given the complexities of the local community and its diverse population. This community faces a high level of risk related to chronic disease and the factors that contribute to these conditions across many different age groups. Therefore, it is necessary to understand the root of these problems and to consider the manner in which individuals might achieve modest yet consistent improvements in health in order to alleviate the symptoms of existing chronic diseases or to minimize their impact as best as possible. Most importantly, it is necessary to incorporate nurses into the practice of evaluating and treating patients with chronic diseases as best as possible, using the community-based resources that are available in this regard. This process also demonstrates the importance of recognizing critical needs within the community that are associated with chronic disease so that management of these conditions is increased and properly addressed in the larger context of nursing practice.

It is believed that chronic disease will continue to cause significant concern the residents of Winterlane in many ways, particularly when they exhibit a number of risk factors that require critical evaluation and focus. These factors represent an opportunity to examine the different constructs of care that impact patients and to be proactive in meeting patient care needs without delays. Nurses who work within the Winterlane community in hospitals, clinics, doctor’s offices, and in community health settings must perform outreach within the surrounding area in an effort to produce viable outcomes and to be proactive in meeting the needs of local residents in the desired manner to minimize the risk of chronic disease and other related concerns. This process will enable nurses to better communicate with local residents and to be proactive in advancing education and screening programs to better protect them from the risks associated with chronic disease. In this capacity, it is important for the Winterlane community to take advantage of the ample nursing-related resources that are available and to be effective in sharing their knowledge with the community in a positive and consistent manner.

References

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Howard, K., White, S., Salkeld, G., McDonald, S., Craig, J. C., Chadban, S., & Cass, A. (2010). Cost?Effectiveness of Screening and Optimal Management for Diabetes, Hypertension, and Chronic Kidney Disease: A Modeled Analysis. Value in Health, 13(2), 196-208.

Hung, W. W., Ross, J. S., Boockvar, K. S., & Siu, A. L. (2011). Recent trends in chronic disease, impairment and disability among older adults in the United States. BMC geriatrics, 11(1), 47.

Katon, W. J., Lin, E. H., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., … & McCulloch, D. (2010). Collaborative care for patients with depression and chronic illnesses. New England Journal of Medicine, 363(27), 2611-2620.

Ludman, E. J., Peterson, D., Katon, W. J., Lin, E. H., Von Korff, M., Ciechanowski, P., … & Gensichen, J. (2013). Improving confidence for self care in patients with depression and chronic illnesses. Behavioral Medicine, 39(1), 1-6.

Maryland Department of Health and Mental Hygiene (2011). Chronic disease in Maryland: facts and figures. Retrieved from http://phpa.dhmh.maryland.gov/cdp/pdf/Chronic-Disease-Maryland-Facts-Figures-2011.pdf

Roebuck, M. C., Liberman, J. N., Gemmill-Toyama, M., & Brennan, T. A. (2011). Medication adherence leads to lower health care use and costs despite increased drug spending. Health Affairs, 30(1), 91-99.

Taggart, J., Williams, A., Dennis, S., Newall, A., Shortus, T., Zwar, N., … & Harris, M. F. (2012). A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC family practice, 13(1), 49.