Chronic care

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Chronic care refers to medical care which addresses pre-existing or long-term illness, as opposed to acute care which is concerned with short term or severe illness of brief duration. Chronic medical conditions include asthma, diabetes, emphysema, chronic bronchitis, congestive heart disease, cirrhosis of the liver, hypertension and depression. Without effective treatment chronic conditions may lead to disability.

Contents

The incidence of chronic disease has increased as mortality rates have decreased. [1] It is estimated that by 2030 half of the population of the USA will have one or more chronic conditions. [2]

According to the CDC, 6 out of 10 adults in the U.S. are managing at least one chronic disease and 42% of adults have two or more chronic conditions. [3]

Conditions, injuries and diseases which were previously fatal can now be treated with chronic care. Chronic care aims to maintain wellness by keeping symptoms in remission while balancing treatment regimes and quality of life. [1] Many of the core functions of primary health care are central to chronic care. [4] Chronic care is complex in nature because it may extend over a pro-longed period of time, requires input from a diverse set of health professionals, various medications and possibly monitoring equipment. [5]

Policy making

According to 2008 figures from the Centers for Disease Control and Prevention chronic medical care accounts for more than 75% of health care spending in the US. [1] In response to the increased government expenditure in dealing with chronic care policy makers are searching for effective interventions and strategies. These strategies can broadly be described within four categories. These are disease prevention and early detection, new providers, settings and qualifications, disease management programs and integrated care models. [6]

Challenges

One of the major problems from a health care system which is poorly coordinated for people with chronic conditions is the incidence of patients receiving conflicting advice from different providers. [2] Patients will often be given prescriptions for medication that adversely interact with one another. One recent study estimated that more than 20% of older patients in the USA took at least one medication which could negatively impact another condition. [7] This is referred to as therapeutic competition.

Effective chronic care requires an information platform to track patients' status and ensure appropriate treatments are given. [8]

There is a recognised gap between treatment guidelines and current practice for chronic care. [9] Individualised treatment plans are critical in treating chronic conditions because patients will place varying important on health outcomes. For example, some patients will fore-go complex, inconvenient medication regimes at the expense of quality of life. [9]

Multiple conditions

One of the greatest challenges in this field of health care is dealing with the co-existence of multiple long-term conditions, also known as multimorbidity. [5] There are few incentives within current health care systems to coordinate care across multiple providers and varying services. [2] A 2001 survey by Mathematica Policy Research found that physicians feel they have inadequate training to deal with multiple chronic conditions. An increase in the number of chronic conditions correlates with an increase in the number of inappropriate hospitalizations. [2] Self-management can be challenging because recommended activities for one condition may be made difficult because of another condition. [9]

Approach

Chronic care is a patient-based approach to provide chronically ill patients with the knowledge and resources to help them better understand their conditions and to help them to adhere with treatment for better outcomes. Chronic care patients may require the services of a variety of care providers, including dietitians, nutritionists, occupational therapists, nurses, behavioral care, pain management, surgery, and pastoral care. Working in collaboration with the patient, the chronic care provider coordinates care these and other specialist providers. Additionally, the patient may require palliative or hospice care, especially at end of life.

See also

Related Research Articles

Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain, illnesses including other problems whether physical, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients.

<span class="mw-page-title-main">Pain management</span> Interdisciplinary approach for easing pain

Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.

<span class="mw-page-title-main">Geriatrics</span> Specialty that focuses on health care of elderly people

Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of the elderly. The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.

Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used interchangeably, but incorrectly, with health psychology. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health.

A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes, functional gastrointestinal disorder, eczema, arthritis, asthma, chronic obstructive pulmonary disease, autoimmune diseases, genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.

<span class="mw-page-title-main">Self-care</span> Taking care of ones own health

Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and actively manage illness when it occurs. Individuals engage in some form of self-care daily with food choices, exercise, sleep, and hygiene. Self-care is not only a solo activity, as the community—a group that supports the person performing self-care—overall plays a role in access to, implementation of, and success of self-care activities.

Multimorbidity, also known as multiple long-term conditions (MLTC), means living with two or more chronic illnesses. For example, a person could have diabetes, heart disease and depression at the same time. Multimorbidity can have a significant impact on people's health and wellbeing. It also poses a complex challenge to healthcare systems which are traditionally focused on individual diseases. Multiple long-term conditions can affect people of any age, but they are more common in older age, affecting more than half of people over 65 years old.

<span class="mw-page-title-main">Caregiver</span> Person helping another with activities of daily living

A caregiver, carer or support worker is a paid or unpaid person who helps an individual with activities of daily living. Caregivers who are members of a care recipient's family or social network, and who may have no specific professional training, are often described as informal caregivers. Caregivers most commonly assist with impairments related to old age, disability, a disease, or a mental disorder.

Prescription cascade is the process whereby the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in further prescriptions and further side effects and unanticipated drug interactions, which itself may lead to further symptoms and further misdiagnoses. This is a pharmacological example of a feedback loop. Such cascades can be reversed through deprescribing.

Chronic care management encompasses the oversight and education activities conducted by health care professionals to help patients with chronic diseases and health conditions such as diabetes, high blood pressure, systemic lupus erythematosus, multiple sclerosis, and sleep apnea learn to understand their condition and live successfully with it. This term is equivalent to disease management for chronic conditions. The work involves motivating patients to persist in necessary therapies and interventions and helping them to achieve an ongoing, reasonable quality of life.

Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists, medical affairs, and RWE scientists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up.

<span class="mw-page-title-main">Iatrogenesis</span> Causation of harm by any medical activity

Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. First used in this sense in 1924, the term was introduced to sociology in 1976 by Ivan Illich, alleging that industrialized societies impair quality of life by overmedicalizing life. Iatrogenesis may thus include mental suffering via medical beliefs or a practitioner's statements. Some iatrogenic events are obvious, like amputation of the wrong limb, whereas others, like drug interactions, can evade recognition. In a 2013 estimate, about 20 million negative effects from treatment had occurred globally. In 2013, an estimated 142,000 persons died from adverse effects of medical treatment, up from an estimated 94,000 in 1990.

Clinical nutrition centers on the prevention, diagnosis, and management of nutritional changes in patients linked to chronic diseases and conditions primarily in health care. Clinical in this sense refers to the management of patients, including not only outpatients at clinics and in private practice, but also inpatients in hospitals. It incorporates primarily the scientific fields of nutrition and dietetics. Furthermore, clinical nutrition aims to maintain a healthy energy balance, while also providing sufficient amounts of nutrients such as protein, vitamins, and minerals to patients.

<span class="mw-page-title-main">Myalgic encephalomyelitis/chronic fatigue syndrome</span> Medical condition

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating long-term medical condition. People with ME/CFS experience lengthy flare-ups of the illness following relatively minor physical or mental activity. This is known as post-exertional malaise (PEM) and is the hallmark symptom of the illness. Other core symptoms are a greatly reduced ability to do tasks that were previously routine, severe fatigue, and sleep disturbances. The baseline fatigue in ME/CFS does not improve much with rest. Orthostatic intolerance, memory and concentration problems, and chronic pain are common. About a quarter of people with ME/CFS are severely affected and unable to leave their bed or home.

Pediatric psychology is a multidisciplinary field of both scientific research and clinical practice which attempts to address the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting. Psychological issues are addressed in a developmental framework and emphasize the dynamic relationships which exist between children, their families, and the health delivery system as a whole.

Childhood chronic illness refers to conditions in pediatric patients that are usually prolonged in duration, do not resolve on their own, and are associated with impairment or disability. The duration required for an illness to be defined as chronic is generally greater than 12 months, but this can vary, and some organizations define it by limitation of function rather than a length of time. Regardless of the exact length of duration, these types of conditions are different than acute, or short-lived, illnesses which resolve or can be cured. There are many definitions for what counts as a chronic condition. However, children with chronic illnesses will typically experience at least one of the following: limitation of functions relative to their age, disfigurement, dependency on medical technologies or medications, increased medical attention, and a need for modified educational arrangements.

A Mental Health Nurse (MHN) refers to a psychiatric nurse in the UK, who specializes in the care of patients with mental health issues.

<span class="mw-page-title-main">Correctional nursing</span> Nursing for prisoners

Correctional nursing or forensic nursing is nursing as it relates to prisoners. Nurses are required in prisons, jails and detention centers; their job is to provide physical and mental healthcare for detainees and inmates. In these correctional settings, nurses are the primary healthcare providers. These nurses also work with victims and assist in expert witness testimonies and are involved in a variety of legal cases including paternity disputes and workplace injuries.

The taxonomy of the burden of treatment is a visualization created for health care professionals to better comprehend the obstacles that interfere with a patient's health care plan. It was created as a result of a worldwide, qualitative-based study that asked adults with chronic conditions to list the personal, environmental, and financial barriers that burden a patient. The purpose of this visualization is to help health care providers develop personalized management strategies that the patient can follow through a narrative paradigm. The goal is to target interventions, achieve an interpersonal doctor-patient relationship, and improve health outcomes.

<span class="mw-page-title-main">High-risk people</span> People with a high risk of severe illness

A high-risk individual, high-risk person, or high-risk population is a human being or beings living with an increased risk for severe illness due to age, medical condition, pregnancy/post-pregnant conditions, geographical location, or a combination of these risk factors.

References

  1. 1 2 3 Larsen, Pamala D. (2011). "Chronicity". In Lubkin, Ilene Morof; Larsen, Pamala D. (eds.). Chronic Illness: Impact and Intervention. Jones & Bartlett Publishers. pp. 3–4. ISBN   978-0763799663 . Retrieved 10 March 2014.
  2. 1 2 3 4 Gerard Anderson (2010). "Chronic Care: Making the Case for Ongoing Care". Robert Wood Johnson Foundation. Retrieved 14 March 2014.
  3. ↑ "Chronic Diseases in America". CDC. CDC. Retrieved 16 November 2020.
  4. ↑ Kane, Robert L.; Reinhard Priester; Annette M. Totten (2005). Meeting the Challenge of Chronic Illness . JHU Press. p.  93. ISBN   0801882095 . Retrieved 15 March 2014.
  5. 1 2 Ellen, Nolte; Cécile Knai; Martin McKee (2008). Managing Chronic Conditions: Experience in Eight Countries. WHO Regional Office Europe. p. 2. ISBN   978-9289042949 . Retrieved 11 March 2014.
  6. ↑ Busse, Reinhard; Miriam Blümel; David Scheller-Kreinsen; Annette Zentner (2010). Tackling Chronic Disease in Europe: Strategies, Interventions and Challenges. WHO Regional Office Europe. p. 3. ISBN   978-9289041928 . Retrieved 11 March 2014.
  7. ↑ Lorgunpai, Songprod Jonathan; Grammas, Marianthe; Lee, David S. H.; McAvay, Gail; Charpentier, Peter; Tinetti, Mary E. (February 25, 2014). "Potential Therapeutic Competition in Community-Living Older Adults in the U.S.: Use of Medications That May Adversely Affect a Coexisting Condition". PLOS ONE. Public Library of Science. 9 (2): e89447. Bibcode:2014PLoSO...989447L. doi: 10.1371/journal.pone.0089447 . PMC   3934884 . PMID   24586786.
  8. ↑ Brodsky, Jenny; Jack Habib; Miriam Hirschfeld (2003). Key Policy Issues in Long-term Care. World Health Organization. p. 78. ISBN   9241562250 . Retrieved 11 March 2014.
  9. 1 2 3 Nolte, Ellen; Martin McKee (2008). Caring For People With Chronic Conditions: A Health System Perspective: A Health System Perspective. McGraw-Hill International. pp. 2, 4. ISBN   978-0335233700 . Retrieved 15 March 2014.
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