What are the five prescriptions for chronic disease management?

At present, the five core prescriptions generally recognized in the field of primary medical care and chronic disease management in China are exercise prescriptions, nutrition prescriptions, psychological prescriptions, smoking cessation and alcohol restriction prescriptions, and drug prescriptions. Some practice systems also list sleep management as a separate item as a supplement or alternative. However, the former is the current mainstream reference standard for chronic disease management services in medical institutions at all levels.

I have been doing chronic disease follow-up in the community for almost 6 years. I have met too many patients who equate chronic disease management with "taking the right medicine". In fact, it is far from the case. Uncle Zhang who came for follow-up last month is a very typical example. The 63-year-old has 12 years of I have a history of high blood pressure and abnormal glucose tolerance. I used to take antihypertensive drugs, but I always felt that they were "three parts poisonous". I secretly cut half of the tablets when I didn't feel dizzy. My blood pressure fluctuated, reaching 180/100 at the highest point, and I felt dizzy even after taking two steps.

Drug prescription is actually the ballast stone of the entire chronic disease management, and it was also the first thing we helped Uncle Zhang smooth out. We adjusted the long-acting antihypertensive drug that is more suitable for him based on his liver and kidney function, and set a rule to take it on an empty stomach at 7 o'clock every morning.

But taking the right medicine is not enough. Uncle Zhang’s previous life habits were too "unrestrained". He couldn't do without pickled radish and drink every meal, and had to eat pickled pork ribs three times a week. If these habits are not changed, no matter how much medicine he takes, the effect will be reduced. The nutrition, smoking cessation and alcohol restriction plan we customized for him did not have too strict requirements. We just said that the daily salt intake should be controlled to the amount of a beer bottle cap, pickled products should be stopped first, and white wine should be given up first. If he is really greedy, he should drink low-alcohol red wine once or twice a month at most, no more than a small cup each time. For meat, steamed fish and skinless chicken breasts are given priority, and vegetables are eaten at least one pound a day. He found it tasteless at first, so we gave him a few low-salt recipes using spices such as peppercorns, star anise, and lemon. He gradually got used to it, and his blood lipids dropped a lot during the review last month.

After the eating rules are set, the exercise plan must also be followed. The exercise prescription is not just for everyone to run a few steps. It must be tailored based on your own physical condition. Uncle Zhang has an old knee injury, so we don’t let him do exercises like running or jumping that can hurt his knees. Instead, we let him walk slowly for 40 minutes in the community park after dinner every day. He also goes to the Tai Chi class in the community for 20 minutes every Tuesday and Friday morning to do the simplified twenty-four poses. When exercising, you don’t have to be tired and sweaty. It’s probably just that you can chat normally while walking, but you can’t sing loudly at the right intensity. On the contrary, too much intensity can easily cause blood pressure to spike.

Many people tend to ignore the role of psychological prescriptions. I once met an aunt who usually measured her blood pressure at home and her blood pressure was normal. But when she went to the hospital clinic, her blood pressure soared to 160. To put it bluntly, she was suffering from emotional stress, which is often referred to as "white coat hypertension." Uncle Zhang was the same before. Because his blood pressure was always unstable, he worried about having a stroke and hemiplegia every day. He tossed and turned at night and couldn't sleep. We roped him into a mutual aid group for chronically ill patients in the community. We usually let him chat with the old guys in the group, and a psychological counselor came to the community every Wednesday to provide free counseling. Gradually, he relaxed, his sleep quality improved, and his blood pressure stabilized a lot.

In the past two years, many colleagues have been discussing whether sleep management should be included in core prescriptions. After all, there are too many chronically ill patients with sleep disorders. Poor sleep has a great impact on blood sugar and blood pressure. Some areas have already piloted the addition of sleep prescriptions. However, a unified national standard has not yet been formed. Most places still use the five prescription system.

After doing chronic disease management for so long, my biggest feeling is that these prescriptions are never separate and have to be matched together, just like the legs of a table. Without any one of them, I can't stand firmly. Uncle Zhang has been undergoing treatment for more than three months now. Last time I took a blood pressure test, it was stable at around 130/80. My glucose tolerance has also improved, and my whole person's mental state is different. This is the effect of the combination of several prescriptions.