Trends in population aging and changes in disease profiles are happening in Hong Kong as well as in other countries around the world. As a result of these changes, chronic illnesses as a group will gradually become the major health care burden. These chronic conditions include diseases such as diabetes, asthma, chronic obstructive pulmonary diseases, hypertension, coronary heart disease, dyslipidaemia, mental health disorders such as depression, and certain communicable diseases such as HIV infection, just to name a few.¹ It has been estimated that chronic conditions will be the main cause of death and disability in the world by 2020.² They will also be responsible for about two thirds of the global burden of disease with enormous health care costs for societies and governments around the globe.^3-5

Hong Kong, as in other countries of the world, has a system that a patient can be looked after by several health care providers. Traditionally there has been a lack of coordination among providers who may duplicate laboratory and radiological investigations, especially if medical records are not shared. Hence, it is high time to explore the feasibility of a safe, reliable and accessible patient information system, allowing different health care providers to share the relevant parts of patients' medical records.

Management of patients with chronic conditions can be improved by the development of evidence based treatment plans or clinical management guidelines. However, simply distributing guidelines is not necessarily followed by their implementation, i.e. change of physician practice. A structured approach to incorporating these guidelines into everyday use is critical to their success in implementation. The guidelines should provide pathways in disease management ranging from acute care to chronic ambulatory care. They should also provide different health care providers with the necessary linkages to coordinate clinical management and to monitor outcomes. It is essential to measure the baselines before starting disease management interventions in order to assess their effectiveness. The application of the concepts of an audit cycle is most appropriate in this setting.

What else can we do from an individual patient's point of view? We can start with empowering the patients, their families and community carers. Health care providers can do more to engage patients and carers in managing their own conditions and to use treatments properly. It is well known that most patients who do not adhere to treatment have poorer health outcomes.⁶ In developed countries only around half of the people prescribed treatments for chronic conditions actually take their medicines.⁷ The non-compliance problem can be due to a multitude of reasons but patient education and explanation is certainly one area that we cannot ignore. It is our duty as clinicians to ensure that our patients and their carers understand more about their conditions and their management plans so that they can be active participants rather than just passive recipients of the process. Patient education should be planned and coordinated.

Chronic diseases present different challenges from other acute clinical conditions. Due to the indulent nature of these diseases, patients with chronic illness require long term follow up as well as chronic and sometimes multiple medications. They also require hospitalisation for excerbations of disease or complications. As these conditions are, more often than not, tackled more successfully by a team approach, they would benefit from a multidisciplinary clinical management. All these have resource implications. With the ever increasing demand on health care and the limited resources available, policy makers will need to look hard at the issues related to how best to manage the increasing burden of chronic conditions.