Chronic Illness

come up with other name for chronic illness

 

 

 

"Living with chronic illness is like flying a small plane"

The current epidemic is chronic illness. This is the challenge we must rise to.

 

• burden of chronic illness
• challenges
• caring for people with chronic illness
• multidisciplinary care in chronic disease management
• chronic illness and community
• references

 

What is Chronic Illness?

Chronic illness includes:

• hypertension
• diabetes
• tobacco addiction
• hyperlipidemia
• congestive heart failure
• chronic atrial fibrillation
• asthma
• depression

 

living with a chronic disease has three components:

• disease process and treatments
• emotional consequences
• changes to daily life as a consequence of the condition

the medical model suggests fixing the disease will fix the emotions and impact on daily life. But why not work from the bottom up as well? Examine people's lives and communities and see what can be done.

 

Burden of Chronic Illness

Chronic illness accounts for up to 75% of total health expenditures (Wagner, 2001)

The acute care model is not reducing the burden and is not sustainable. All policymakers are focused on health care reform.

Episodic, crisis-based care does not work and is very costly.

 

In Nova Scotia,

• CV disease - 36% of deaths
• cancer - 30% of deaths
• arthritis - 16% of Nova Scotians
• chronic illness is 13% of NS GDP

Coleman, 2002

The majority of people with chronic illness are not adequately cared for.

 

The tyranny of the urgent frequently crowd out chronic health concerns.

 

exposure - problems - symptoms - subjective experience

subjective experience is not well taken to

 

Longe term management is necessary because of non-reversible injury.

The health care system is not really prepared to deal with them because of:

• complexity
• mulit-system illness

 

peple need to be committed to change

society needs to be willing to accomodate people with disability

need research at all levels: EBM

 

 

Caring for People with Chronic Illness

The majority of care is provided in the primary care setting, necessitating a mjaor rethink of primary care.

First, love the people who need help. If you don't care about them, little will work.

There are no quick fixes for improving care of people with chronic illness.

"Too often, caring for people with chronic illness features an uninformed, passive patient interacting with an unprepared practice team, resulting in frustrating, inadequate encounters." (Bodenheimer et al, 2001)

 

 

There are six essential elements of chronic care:

 

community resources and policies

There need to be strong links to community-based resources.

 

health care organization

An organization's goals and values need to be in line with primary care provision and determine relationships with purchasers, insurers, and other providers.

Funding support is a major player here and need to reward chronic care quality and improvements.

 

self-management support

For chronic conditions, patients themselves become the principal caregivers. People live with their conditions for many years, many aspects of management are under direct control of people, including:

• diet
• exercise
• self-measurement (glucose, bathroom scales)
• medication use

Self-management support includes collaboratively helping patients and families acquire skills and confidence to manage chronic illness.

 

People need to be empowered and equipped (confidence and skills - two different things) to take ownership and self-manage:

• blood pressure
• glucose
• diet
• referrals to community organizations
• routine assessment of problems and accomplishments

 

delivery system design

decision support

clinical information systems

 

Chronic Illness tools

The CMA supports Mydoctor.ca ,which is an online means of working with patients to monitor performance. A writeup (ad plug) is here

 

Multidisciplinary Care in Chronic Disease Management

There needs to be a clear division of labour and plan to separate acute care from planned management of chronic conditions.

 

Some folks suggest the physician should:

• treat acute problems
• intervene in difficult chronic conditions
• train team members

Non-physician personnel should:

• arrange routine periodic tasks:
  • support patient self-management
  • lab tests, eye exams, foot exams
  • ensure appropriate follow-up, with planned visits
  • contact people at home to see how they are doing

Specialty expertise needs to be a mere phone call/email away, not requiring a full referral.

 

Clinical Information systems

 

There can be a perceived link between exposure and onset of problem and the environemtn

 

aggrevation of existing symptoms

 

 

Chronic Illness and Community

 

References

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with
chronic illness. JAMA. 2002; 288(14):1775-1779.

• this paper outlines 6 components of primary care and provides case studies of US groups.

Coleman R. The Cost of Chronic Disease in NS, GPI Atlantic, Oct 2002

• perhaps the best source of chronic illness information in NS

Wagner EH. Meeting the Needs of Chronically Ill People. BMJ 2001; 323:945-946.