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.
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The incidence of chronic disease has increased as mortality rates have decreased. It is estimated that by 2030 half of the population of the USA will have one or more chronic conditions.
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. Many of the core functions of primary health care are central to chronic care. 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.
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. 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.
Challenges
One of the major problems from a health care system which is poorly coordinated for sufferers of chronic conditions is the incidence of patients receiving conflicting advice from different providers. 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. This is referred to as therapeutic competition.
Effective chronic care requires an information platform to track patients' status and ensure appropriate treatments are given.
There is a recognised gap between treatment guidelines and current practice for chronic care. 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.
Multiple conditions
One of the greatest challenges in this field of health care is dealing with the co-existence of multiple disorders, which is called multi-morbidity. There are few incentives within current health care systems to coordinate care across multiple providers and varying services. 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. Self-management can be challenging because recommended activities for one condition may be made difficult because of another condition.
Approaches
A nurse has to be qualified to handle all the needs of a chronic client and has to be an advocate to put the case of the chronically ill across to the health administration, hospital board or their families.
A variety of specialists such as surgeons, dietitians, nutritionists, and occupational therapists have to be in attendance for the maximum benefit of the client. Someone suffering from chronic pain for a long time may need the help of a psychiatrist. Everyday activities that the physically fit see as normal may be a Herculean feat for the chronically ill and they need all the support that they can get. The nurse may be privy to some of these help that the chronically ill can benefit from. They need to be proactive and put these patients in contact with these help but also sensitive enough to give their client the freedom to decline any help if they think that they do not need it.
Chronic pain might also get the person to start questioning their faith and/or wanting to have a deeper spiritual experience because of their pain and suffering.
The patient also needs to take time to participate in some fun activities. They may need to check out of the facility/hospital or get out of the house occasionally preventing an association of hospitals with pain. This further helps the patients keep their sanity and keeps them psychologically sound.
They may need a nurse who is qualified in palliative care. Some may be dying and they need respect and dignity as they die in pain. They also need a nurse who is non-judgmental and one who is also compassionate and caring. The family has to be involved to help the client better manage the pain. One very important quality is co-ordinating the best care for the client and some amount of diplomacy and empathy.
In some cases, such as with diabetes or sleep apnea, the treatment is long term and difficult for patients to understand and comply with. In theses cases chronic care management is highly recommended to help the patient learn about the consequences of refusing treatment and how to best follow treatment.