The Impact of Chronic Illness Assignment Paper

The Impact of Chronic Illness Assignment Paper The Impact of Chronic Illness Assignment Paper The purpose of this study was to assess the impact of chronic illness on patients in relation to its physical, psychological, and social effects, and its effects on activities of daily living. A structured questionnaire was used to interview 177 patients. Chronic illness had the greatest effect on psychological functioning, followed by physical and social functioning. The least affected aspects of a patient’s functioning were related to performing activities of daily living (ADLs). Results indicated that the diagnosis, duration of disease, and developmental stage of the patient’s children were useful in predicting the impact of a chronic illness on a patient’s physical functioning. Diagnosis, duration of disease, and economic status had a significant impact on a patient’s psychological functioning. Diagnosis, duration of disease, age, sex, occupation, education, and marital and economic status were important factors relative to social functioning. Diagnosis, age, marital status, the developmental stage of the children, and the primary caregiver were the most important factors related to the effects of chronic illness on ADLs. The results of the study serve as a guide for a comprehensive assessment of chronically ill patients.The Impact of Chronic Illness Assignment Paper Permalink: https://nursingpaperessays.com/ the-impact-of-ch…assignment-paper / ? Advances in medicine have prolonged the life of many people with chronic diseases. Chronic diseases may not kill but they consume a lot of health care resources and threaten the quality of life of the sufferers. 1 – 11 The ultimate goal of modern health care for patients with chronic disease is not only to delay death but also to promote health and quality of life. Health-related quality of life (HRQOL) has become an important measure of the outcome of care for patients with chronic diseases in the last two decades. It has also been found to be predictive of health service utilization and mortality. 2 , 12 – 14 It is subjective and should include the essential domains of physical, psychological, daily role and social functioning, and general health perception The Impact of Chronic Illness Assignment Paper Australia’s population is ageing: our average healthy life expectancy of 73.2 years is second only to that of Japan (74.5 years).1 Total life expectancy is some 10 years longer, but this further longevity may be accompanied by significant and increasing disabilities.2 Burden-of-disease data show that depression, dementia, asthma, osteoarthritis, hearing loss and diabetes account for nearly 30% of the years of life lost due to disability in Australia. These are all chronic conditions that are increasingly prevalent,3 in the face of healthcare workforce shortfalls in Australia.4 Thus, there is a need to explore alternative models of healthcare delivery. These need to be collaboratively developed and should provide a range of healthcare professionals with broad knowledge and competency to care for patients with chronic illness.The Impact of Chronic Illness Assignment Paper Recently, Wagner defined what constitutes a patient care team and outlined strategies necessary for the effective functioning of chronic disease programs.5 A patient care team comprises diverse healthcare professionals who communicate regularly about the care of a defined group of patients and participate in that care on a continuing basis.6 The strategies that underpin this team care include:5 Population-based care; Treatment planning, which should be negotiated with the patient; Evidence-based clinical management; Self-management support, with the emphasis on patient self-education, self-care and counselling in behavioural change; More effective consultations; and Sustained follow-up, which may not need to be face to face, but could be carried out, for example, over the telephone The Impact of Chronic Illness Assignment Paper It is apparent that some elements of a chronic disease management program (Box 1) need not involve clinicians. But one important issue that does is that of “managing” the team. This is still seen to be the responsibility of a healthcare professional, but increasingly there is a need for specific management expertise within the team. Role delineation is also an important issue. In the paradigm of diagnosis and management, there is no doubt that medical graduates have the major role in diagnosis and initial assessment of patients, but management can and should be shared with other healthcare professionals.9 The development of team care for chronic disease needs to involve and cater for both institutional and community care, and these may be very “system” dependent: public and private hospitals and community facilities can have quite different systems and approaches. Current organisational structures for healthcare delivery are discipline-based, but we need to abandon this paradigm in dealing with chronic disease. Healthcare structures are often, by their nature, hierarchical “ego systems”10 and can interfere with the ability to develop comprehensive healthcare delivery services. It is important to break through the barriers between these “silos”.The Impact of Chronic Illness Assignment Paper The concept of multidisciplinary disease clinics where orthopaedic surgeons and rheumatologists work closely with physiotherapists is well accepted. Cardiologists and cardiac surgeons combine to provide advice on acute intervention in chronic cardiovascular disease. These concepts work well within the hospital system, but need to be adapted for community care. Another problem with disease management for chronic conditions is that the healthcare system is predominantly geared for healthcare professionals rather than for patients, and for episodes of acute care (albeit often in chronic disease) rather than for chronic care. In the shift of care delivery, it is critical that the “team” work across the interfaces of the community and institutions and that communication between specialists and the primary care teams be maximised for the patients’ good. The development of multidisciplinary disease-specific healthcare delivery teams helps to break down those barriers, but patients need to be involved more in that dialogue. Future healthcare professionals will need to have some skills or knowledge of case management and integration of care. They will need to: Be aware of health promotion and disease prevention issues; Be able to act as the patient’s advocate; and Empower patient self-care through education and provision of basic skills for self-care. Patients with chronic disease will have increasing knowledge of their conditions and will want to be involved in decision-making. Healthcare professionals will need to be aware of this patient empowerment The Impact of Chronic Illness Assignment Paper These issues of health promotion, patient advocacy and patient empowerment, along with education in healthcare systems, need to be addressed at both undergraduate and postgraduate levels so that future healthcare professionals will understand the vagaries of healthcare systems — how they work and how they can be made to work better, and how to promote patient self-management. In a way, the aim is to shift the healthcare system from one concerned with “illth” to one concerned with “health”. Many of these skills may be acquired by healthcare professionals through multidisciplinary learning. Programs can be developed in which individuals from different disciplines learn together around particular clinical problems, and see what skills each can bring to the problem.12 The “generic” healthcare professional There may be a role for a more “generic” healthcare professional who has a defined range of allied health skills (physiotherapy, occupational therapy, nursing, etc), but not necessarily the specialty expertise of any one discipline. These people would work closely with other members of the healthcare team, particularly general practitioners. “Generic” healthcare professionals with various skills may be useful in the care of patients with chronic disease or in assessing elderly patients in a community setting. They might be particularly useful in rural areas where allied health professionals are often in short supply. These “generic” healthcare professionals could use technologies such as video or computer to link with specialists, medical or other (physiotherapists, pharmacists, etc), in urban centres. Similarly, “generic” healthcare practitioners with skills in acute resuscitation, dental care, basic physiotherapy, counselling and limited prescribing could provide useful care in local communities, especially if they have contact with, and are regarded as part of a team of, healthcare professionals in regional centres. This model might also have a place in providing services in community aged-care facilities, closely linked with local general practice and community services.The Impact of Chronic Illness Assignment Paper Data from the United States suggest that partnerships between primary care physicians and “advanced practice nurses” can provide better patient outcomes.13 If the training of advanced practice nurses were extended to include knowledge of physiotherapy, occupational therapy and pharmacy, these “generic” healthcare professionals could provide a broad range of advice and services in partnership with other disciplines. Assessing alternative systems The important issue is that we should consider alternative models of healthcare delivery for chronic disease, and assess whether they might work in Australia. In some other areas of healthcare, particularly in the US and Europe, other healthcare professions have taken on roles hitherto considered the purview of the doctor. Nurse anaesthetists are well accepted in Scandinavia, where they have an important role in assessing chronic pain and managing post-operative pain.14 , 15 The idea of “medical practitioner assistants”, where nurses or others can be trained to be anaesthetic assistants or assist in other procedures, has long existed in the US. The supply of non-medical clinicians in the US is growing significantly, with the number of non-physician clinicians in primary care expected to be equivalent to 20% of the supply of physicians by 2015.16 A recent US study17 of the trend towards care by non-physician clinicians has shown that, although the number of patients visiting non-physician clinicians is increasing, many are seeing physicians as well. This is accompanied by a shift towards the provision of preventive services by non-physician clinicians and an increase in the proportion of patients seen by both types of providers. It is important that these physicians and non-physicians are truly complementing each other, delivering the same services to different groups or different services to the same group. For patients, the type of clinician may be less important than whether the care meets their needs and achieves a “better” or “equivalent” outcome. The success of these models depends on close collaboration and communication between the various care providers. It is important to evaluate these models carefully from the start to ensure that continuity and quality of care are not reduced The Impact of Chronic Illness Assignment Paper We need to work together to identify tasks performed by one professional group that might be equally well performed by others. This would then free that group to concentrate their expertise in other important areas. For example, pharmacists or nurses might be involved in providing repeat prescriptions, or reviewing medication and compliance; radiographers or expert systems could be involved in x-ray interpretation; and human movement professionals might be involved in exercise programs for obesity, osteoporosis and chronic arthritis. Optometrists might play a role in the management of specified eye problems. Indeed, it should be asked whether it is possible to train non-medical practitioners to perform specific procedures such as gastrointestinal tract endoscopy, cataract extraction or arthroscopy. We could also consider professional groups outside the healthcare system, such as teachers. Developing closer links between the healthcare and education systems could have significant effects on what children learn about the most important thing they have — their own bodies. Teachers could play a very important public health role as health educators to children in the 8–16-year age bracket. Development of basic knowledge, particularly on the importance of exercise, could play an important role in reducing the current epidemic of obesity in young people, which will inevitably lead to chronic diseases such as diabetes, arthritis and cardiovascular disease.The Impact of Chronic Illness Assignment Paper The aim of this study was to assess the impact of chronic diseases on the HRQOL of Chinese patients in a primary care clinic in Hong Kong. Most previous studies on the relationship between chronic diseases and quality of life were carried out in Western populations, which might not be applicable to our population, 96% of whom are Chinese. 18 We wanted to know whether different diseases affected HRQOL differently and whether one aspect of HRQOL might be affected more than others. We hoped that the information could help doctors and health administrators to identify the needs of patients with chronic diseases better so that their services could be more patient-centred. The impact of each chronic disease on HRQOL was measured in terms of the likelihood of sub-optimal functioning or health instead of numerical scores used by many other studies. 4 – 6 , 8 We hoped that this would make the clinical significance of the results easier to interpret, and that doctors in primary care could use them to predict the risk for their patients.The Impact of Chronic Illness Assignment Paper Many earlier studies have shown that co-morbidity is common and may influence the patients’ HRQOL. 6 – 8 , 11 , 19 – 21 Demographic factors such as age, gender and socioeconomic status could also affect people’s health perception. Therefore, we also estimated the effect of each chronic disease and compared their relative impact independently of the effects of demographic factors and co-morbidity. The study was carried out in a teaching family medicine practice in Hong Kong. The practice was one of 60 Government outpatient clinics (GOPCs) which provides low-cost primary care for the public. The majority of patients with chronic diseases in Hong Kong are followed up in GOPCs for financial reason. 18 At the time of the study, the practice had 5305 Chinese patients with an average of 70 persons consulting each day. All patients aged 18 years or above consulting the practice from July 5 to August 3, 1995 were invited to take part in the study. Each patient in the study was interviewed with a structured questionnaire before the consultation with the doctor. The subject answered the questions in person unless he/she could not communicate, in which case the accompanying person (proxy) answered the questionnaire.The Impact of Chronic Illness Assignment Paper The questionnaire consisted of questions on demographic and morbidity data and the Chinese version of the Dartmouth COOP Functional Health Assessment Charts/WONCA (COOP/WONCA charts). Morbidity data were collected by a checklist for the presence of eight common chronic diseases that represented a wide range of problems from the asymptomatic to the potentially fatal. Each respondent was asked specifically if he/she had ever been diagnosed by a doctor as having hypertension, diabetes mellitus, asthma or chronic obstructive pulmonary disease (COPD), heart disease of any kind, stroke, osteoarthritis (OA) of the knee, joint diseases other than those of the knees (other joints) and depression. Asthma and COPD were considered as one group because there is considerable clinical overlap between them. No distinction was made for the different types of heart diseases because patients cannot always tell the difference between them. The records of the respondents were also reviewed for the presence of these diagnoses. A subject was considered to have the particular disease if he or she was sure that such a diagnosis had been made by a doctor or the diagnosis was documented in his/her record.The Impact of Chronic Illness Assignment Paper The COOP/WONCA charts consist of one chart each on physical fitness, feelings, limitation in daily activities, limitation in social activities, overall health and change in health. They have been validated and tested on patients in primary care in different cultures including the Chinese. 22 , 23 The first five charts cover the essential concepts of HRQOL. 15 – 17 The chart on change in health does not assess HRQOL but provides additional information for the interpretation of the results of the other charts. Each chart is rated on a five-point Likert scale, with higher scores indicating worse function or health status. A summary of the questions and response choices of the COOP/WONCA charts is shown in Appendix A.The Impact of Chronic Illness Assignment Paper The scores of each of the five COOP/WONCA charts on HRQOL were grouped into two categories (optimal and sub-optimal) for further analysis. The optimal category consisted of scores 1 and 2 and the sub-optimal category consisted of scores 3, 4 and 5 for the charts on physical fitness, feelings, daily activities and social activities. Scores 1, 2 and 3 were grouped into the optimal category, while scores 4 and 5 were grouped into the sub-optimal category for the overall health chart. The proportions of sub-optimal COOP/WONCA scores for each disease group were compared with those of patients without any of the chronic diseases (control group). The difference in proportion between them was tested by the chi-square test. The effects of diagnosis, age, social class by occupation, 24 marital status, education and gender on the COOP/WONCA scores were analysed by multivariate forward logistic regression. All the independent variables were fitted together into the logistic regression model, and P -values ?0.05 were considered statistically significant. All data analyses were carried out by the SPSS for Windows 8.0 program The Impact of Chronic Illness Assignment Paper Seven hundred and sixty (97.8%) of 777 eligible patients completed the survey. Twenty-three (3%) of the questionnaires were answered by proxies. There were 222 (29.2%) males and 538 (70.8%) females. The mean age was 57.6 years (range 18–94 years, SD 18). One hundred and ninety-one (25.1%) people were not known to have any of the surveyed chronic diseases, 202 (26.6%) had one, 188 (24.7%) had two, 89 (11.7%) had three, 28 (3.7%) had four, three (0.4%) had five and one (0.1%) each had six and seven of the chronic diseases. Fifty-seven (7.5%) people were not sure if they had any of the diagnoses. The number of persons and demographic characteristics of the sample and each disease group are shown in Table 1. Patients with chronic diseases were more likely than controls to be older, less educated, unskilled workers and persons whose spouses were deceased.The Impact of Chronic Illness Assignment Paper Table 2 compares the unadjusted proportions of sub-optimal COOP/WONCA scores of each disease group with those of patients without any of the diagnoses (control group). Apart from hypertension and diabetes mellitus, the presence of any one chronic disease tended to increase the risk of sub-optimal scores for all the charts. The differences in physical fitness scores were statistically significant for all disease groups. The difference in the feelings scores was statistically significant for depression. The differences in daily activities scores were significant for stroke, OA of the knee, other joint diseases and asthma/COPD. The difference in social activities scores was significant for depression. The differences in the overall health scores were significant for asthma/COPD and depression.The Impact of Chronic Illness Assignment Paper Table 3 shows the results of multivariate forward logistic regression of the COOP/WONCA scores on each diagnosis and demographic variables. Subjects who were unsure of the diagnosis were categorized into the ‘absence of the diagnosis’ group for the logistic regression in order not to exclude too many cases from the analysis. All the odds ratios for sub-optimal COOP/WONCA scores shown were significant at the 5% level. Each odds ratio was the ratio between the odds of a sub-optimal score of those with and those without the relevant diagnosis, after controlling for the effects of demographic variables and co-existing chronic diseases. Most odds ratios approximated the relative risks since the absolute risk in the unexposed was <20%, except for the physical fitness score. The odds ratios of sub-optimal physical fitness scores for hypertension and depression corresponded to relative risks of 1.3 and 1.8, respectively The Impact of Chronic Illness Assignment Paper The effects of most chronic diseases on the physical fitness score became insignificant when they were controlled for demographic variables and co-morbidity. Hypertension increased the odds of sub-optimal physical fitness scores but reduced the risk of sub-optimal feelings and overall health scores. Diabetes mellitus significantly reduced the likelihood of sub-optimal scores for feelings, social activities and overall health. Heart disease did not have any significant independent effect on any COOP/ WONCA scores. OA of the knee increased the risk of sub-optimal scores for daily activities and overall health. Stroke, other joint diseases and asthma/COPD each increased the risk of sub-optimal scores for daily activities. Depression was a risk factor of sub-optimal scores for all but the daily activities charts. Age, educational level and gender had some effects on the COOP/WONCA scores but social class and marital status had no effects. Increasing age increased the risk of sub-optimal physical fitness scores. Education decreased the likelihood of sub-optimal physical fitness scores when compared with no formal schooling (primary education OR = 0.4925, CI = 0.32–0.75; secondary education OR = 0.4096, CI = 0.25–0.68; tertiary education OR = 0.3075, CI = 0.14–0.69). Females were more likely than males to have sub-optimal feelings scores.The Impact of Chronic Illness Assignment Paper This study confirmed that many chronic diseases had an adverse effect on the HRQOL of Chinese patients and that different conditions affected different aspects of life. Sixty-seven per cent of subjects had at least one of the eight chronic diseases, and 41% had more than one. These prevalences were relatively high compared with those reported in the literature. 3 , 19 , 21 This was because the study practice was a GOPC, which had a high proportion of elderly patients with chronic diseases. The unadjusted risks of sub-optimal COOP/WONCA scores shown in Table 2 represented what primary care doctors might expect to find in the real clinical setting. A Chinese patient with depression is likely to have an 88% chance of reporting sub-optimal physical fitness, a 36% chance of moderate to severe emotional problems, a 26% chance of limitation in his/her social activities and a 32% chance of fair or poor health. These risks were twice or more than those expected for patients without any of the common chronic diseases. Some of the observed effects might be the result of the patient’s age, gender, educational level or co-existing diseases, but some demographic and morbidity characteristics tend to cluster together and it is almost impossible to separate one effect from the other in clinical practice. 20 On the other hand, it is important to control for the effects of co-morbidity and demographic variables in the evaluation of the effectiveness of care and medical risk adjustment so that these confounding factors will not bias the results.The Impact of Chronic Illness Assignment Paper The finding that heart diseases were not associated with any significant effect on any COOP/WONCA score was unexpected since previous studies showed that they adversely affected all HRQOL domains. 4 , 5 There was a tendency for our cardiac patients to have a higher risk of sub-optimal scores for all the COOP/WONCA charts than the controls, although the differences did not reach statistical significance. This suggested the possibility of a type II statistical error in that the sample size of 49 subjects was too small to show a statistical significance for a small effect. 27 However, a statistically significant change might not be clinically important and further studies are required to determine the minimum clinically important change in quality of life rating for cardiac patients. The other possible explanation was that 86% of the cardiac patients in this study had co-existing chronic diseases; the effects of these diseases might have ‘cashed in’ before heart disease could be entered into the regression model. The last, but not the least important, reason was that cardiac patients with severe disease or disability are followed up by cardiologists, thus most patients in primary care have only mild diseases with little disability. An evaluation on a larger sample of cardiac patients with different severities of illness could help to clarify the relationship between heart disease and HRQOL.The Impact of Chronic Illness Assignment Paper It seemed contradictory that diabetes mellitus reduced the risk of sub-optimal scores for feelings, social functioning and overall health. De Grauw et al. and others have shown that diabetes mellitus was associated with worse ratings in both physical fitness and overall health domains. 5 , 11 Our finding was unlikely to be a confounding effect of co-morbidity because the latter was controlled for in the regression analysis and the majority of patients with diabetes mellitus did not have other chronic diseases except hypertension. Quality of life rating is subjective and relative to the person’s life expectation. It has been found that successful adjustment has a positive effect on patients’ perceived HRQOL. 28 Differences in people’s adaptation to their illnesses and life expectations between the Chinese and Western cultures could be the reason for the different results. The Chinese culture promotes endurance, acceptance and adaptation to one’s fate, including the presence of illnesses. Chinese patients with diabetes mellitus might down-regulate their expectations for life and would feel happy and contented as long as they remained asymptomatic and free from complications. They might even consider themselves fortunate and rate their health status more positively compared with the worst that they could expect from their illness. The promotion of a positive attitude could be as important as perfect glycaemic control in the care of diabetic patients.The Impact of Chronic Illness Assignment Paper Depression was the most disabling disease affecting not only the psychological well-being but also the physical and social functioning of the person. This finding reinforces the importance of recognizing and treating this disease adequately in primary care. The effect of depression on physical fitness has not been found by others. 5 , 10 Physical and mental health are often considered to be two independent factors of HRQOL, and psychological diseases are not expected to affect the physical component of health. 16 This unique finding in our patients could be due to a cultural tendency for Chinese patients to somatize their psychological problems The Impact of Chronic Illness Assignment Paper Patients seemed to perceive OA of the knee to be more disabling than hypertension, diabetes mellitus and heart disease, although these latter three diseases are regarded as the most important chronic diseases by doctors. The amount of resources and number of research studies on hypertension, diabetes mellitus and heart diseases are countless, but those invested in the care of patients with OA are negligible. 14 There seems to be a discrepancy between how doctors and patients define the importance of an illness. OA of the knee is often ignored by doctors until the disease is very advanced because it does not kill and is often considered a ‘normal’ ageing process. 14 , 30 This study and that by De-Bock et al. consistently showed that OA of the knee was a risk factor, independent of associated psychosocial factors or co-morbidity, of limitation in daily activities and poor general health. 6 Research on the pathophysiology and mechanics of the knee joint has not advanced the care for patients with OA of the knee very far; it may be time for a paradigmal shift towards a more patient-centred approach to this disabling disease The Impact of Chronic Illness Assignment Paper The effects of hypertension on HRQOL reported in the literature are variable. 4 , 5 , 8 Our findings of a negative effect on physical fitness but a positive effect on feelings are similar to those of Krousel-Wood et al. 8 and Nelson et al. 5 Krousel-Wood et al. also found that females with hypertension had better overall health ratings than females seen for other conditions. 8 This study was carried out among patients in primary care who tended to have milder diseases and more stable conditions than patients under specialist care; therefore, the results may not be applicable to the latter setting. Furthermore, the findings from patients of one clinic might not be generalizable to all primary care practices in Hong Kong. We realize that self-reported data are subject to measurement errors, but the same bias should have been present for the disease and control groups so it should not have affected the results of the relative risk estimation and regression analysis.The Impact of Chronic Illness Assignment Paper The numbers of patients in the heart disease, asthma/ COPD and stroke groups were small; the sample sizes had enough power to detect only a medium effect of 15–20% difference in proportions. 27 This study could not exclude some small effects that these chronic diseases might have on the quality of life of patients. We would also like to point out that the controls in this study could have diseases other than the eight chronic conditions surveyed, which could have deflated the difference in HRQOL ratings between them and the ‘disease’ groups. With these limitations, the study did prove that measurement of HRQOL was feasible for Chinese patients in a busy primary care clinic and gave a different perspective on how the importance of a disease could be defined. This study confirmed that many common chronic diseases adversely affected the quality of life of Chinese patients, as they did for Caucasian patients. Depression, OA of the knee, other joint diseases, stroke, asthma/ COPD and hypertension were each associated with a 30–200% relative increase in the risk of disability or ill health measured by the COOP/WONCA charts. Depression was the most disabling disease and daily role functioning was the most commonly affected HRQOL domain.The Impact of Chronic Illness Assignment Paper OA of the knee was more disabling than hypertension and diabetes mellitus from the patients’ point of view. This raised the questions of how the importance of a disease should be measured and whether doctors or patients should be the judges. We need to include HRQOL as a routine outcome measure of care for patients with chronic diseases if health services are really for the betterment of the quality of life of people. The positive impact of diabetes mellitus on HRQOL and the negative effect of depression on physical fitness found in our Chinese patients has not been reported in other cultures. Further studies on more representative samples are required to confirm whether there are true cultural differences in how Chinese people adjust to chronic diseases. It would be useful if we could identify the postitive and negative coping behaviours in each culture so that appropriate counselling could be given to patients. The Chinese are the world’s largest ethnic group who live in all parts of the world. We hope doctors world-wide will be more aware of the possible impact of chronic diseases on the quality of life of their Chinese patients.The Impact of Chronic Illness Assignment Paper What are some effects of a chronic illness? In addition to disease speci