Chronic Disease Flashcards
1
Q
What percent of people deaths each year are due to chronic diseases?
A
70%
2
Q
what percent of deaths are due to heart disease and cancer?
A
50%
3
Q
what percent of adults have chronic diseases?
A
50%
4
Q
what is the most common disability
A
arthritis
5
Q
what is the leading cause of kidney failure, non-traumatic lower-extremity amputations, and blindness?
A
diabetes
6
Q
what are four modifiable health risk behaviors are related to suffering, illness, and death of chronic diseases?
A
- lack of physical activity
- poor nutrition
- tobacco use
- excessive alcohol consumption
7
Q
what are health care costs driven by?
A
advancing technology applied to an aging population with chronic diseases
8
Q
what percent of healthcare costs in US go to chronic diseases?
A
80%
9
Q
how is chronic disease largely managed?
A
patient knowledge
behavior change
10
Q
how do the onset and duration of chronic diseases compare to acute diseases?
A
chronic - gradual onset and indefinite durations
acute - rapid onset and short durations
11
Q
how do the causes and treatments of acute illness and chronic illness differ?
A
chronic - many causes and cures are rare
acute - usually one cause and cures are common
12
Q
how do the Dx and Dx testing of chronic and acute diseases differ?
A
chronic - diagnosis often uncertain (especially early) and Dx testing usually has limited value
acute - commonly accurate diagnosis and often useful testing
13
Q
how do the role of the pt and professional in acute and chronic diseases differ?
A
- chronic: professional serves as teacher and partners, pt serves as partner with health professionals, responsible for daily management
- acute: professional selects & conducts treatment and patient follows orders
14
Q
What components make up with vicious cycle of chronic disease?
A
- pain
- disease process/disability
- depression
- stress
15
Q
what happens as you transition from disease process/disability to depression?
A
loss of self-esteem
16
Q
what happens as you transition from depression to stress?
A
loss of control
17
Q
what happens as you transition from stress to pain?
A
muscle tension
18
Q
what happens as you transition from pain to disease process/disability?
A
immobility
19
Q
what is erratic adherence?
A
failure to follow treatment because it is difficult and/or there are lifestyle disruptions that interfere with regimen
20
Q
what is unwitting non-adherence?
A
pt believe they are complying but fail to do so due to language & culture barriers, cognitive impairment, lack knowledge
21
Q
what is intentional non-adherence
A
make a clear decision to alter or stop treatment
22
Q
Maslow’s theory of ______ and _____.
A
Motivation and Human Needs
23
Q
What is level 5, needs & motivation/behavior, of Maslow’s theory of Motivation and human needs?
A
Self-actualization
needs - fulfillment of goals & dreams
motivation & behavior - creativity
24
Q
what is level 1, needs & motivation/behavior, of Maslow’s theory of Motivation and human needs?
A
Your body
needs - physical safety & security
motivation & behavior - survival skills
25
what is level 2, needs & motivation/behavior, of Maslow's theory of Motivation and human needs?
Family & work
needs - social safety & security
motivation & behavior - survival skills
26
what is level 3, needs & motivation/behavior, of Maslow's theory of Motivation and human needs?
love & relationships
needs - communication & response
motivation & behavior - validation
27
what is level 4, needs & motivation/behavior, of Maslow's theory of Motivation and human needs?
self - esteem
needs - self-respect & acceptance
motivation & behavior - brainpower
28
What are the 7 effects of chronic disease?
- decreased level of activity
- change in daily activities
- decreased sex drive/ability
- decreased self-esteem (altered body image)
- changes in roles (relationship stress)
- fear of abandonment
- negative emotions: sadness, greif, anger, loss of control, anxiety
29
Top 5 leading causes of death?
- heart disease*
- cancer*
- lower respiratory disease*
- accidents
- stroke*
* = top 4 causes in VA
30
What is Healthy People 20/20?
National health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats.
31
Goal for heart disease & stroke from Healthy People 20/20?
1. utilize prevention, detection, and treatment of risk factors
2. early identification and treatment
3. prevention of repeat events
32
what percent of adults have heart disease?
33%
33
what chronic diseases are most preventable?
heart disease & stroke
34
Leading modifiable risk factors for heart disease & stroke?
- high BP
- high cholesterol
- smoking
- DM
- poor diet & physical activity
- overweight/obesity
35
goal of DM from healthy people 2020?
1. reduce DM
2. reduce economic burden of DM
3. improve quality of life for ppl with/at risk for DM
36
by how much does DM lower life expectancy?
15 years
37
Does DM increase risk of heart disease?
yes, 2-4x
38
goal of obesity, healthy people 2020?
promote health and reduce chronic disease risk via healthy diet, & achievement/maintenance of healthy body weights
39
people who are overweight or obese are at risk of what?
- high BP
- coronary heart disease
- gallbladder disease
- sleep apnea
- cancer
- T2 DM
- stroke
- osteoarthritis
- respiratory problems
40
Goal of cancer 2020?
reduce new cases
| reduce illness, disability, death
41
what is the second leading cause of death in US?
cancer
42
what percent of people are expected to be alive 5 years after diagnosis of cancer?
40%
43
What risk factors reduce risk of cancer?
- tobacco products
- physical inactivity & poor nutrition
- obesity
- UV light exposure
44
what is goal of respiratory disorders 2020?
promote respiratory health through better prevention, detection, treatment, and education efforts
45
what are the significant public health burdens related to respiratory disorders?
asthma
COPD
obstructive sleep apnea
46
is COPD preventable?
Yes
47
what are the 2 most common causes of chronic illness in children?
```
#1 chronic sinusitis
#2 asthma
```
48
what populations are at the greatest risk for death from asthma?
- african americans
- hispanics
(2-6x more likely than caucasians)
49
what to address when assessing risk factors?
- unhealthy eating
- physical inactivity
- overweight
- tobacco use
- under-use of screening practices (cholesterol, lipids, blood pressure, blood sugar, pap smear, mammography, bone density)
- alcohol abuse
50
how long should kids and adults be active each day?
kids - 60 minutes
| adults - 30
51
what amount of activity is required to prevent weight gain or sustain weight loss?
60-90 minutes
52
How much grain should be consumed daily? what type?
6 ounces
| half should be whole grains
53
how much vegetables should be consumed daily?
2.5 cups
| vary type
54
how much fruit should be consumed daily?
2 cups
vary type
not too much juice
55
how much dairy should be consumed daily? what type?
3 cups
| low fat or fat free
56
how much meat should be consumed daily? what type
```
5.5 ounces
lean cuts
seafood
beans
avoid frying
limit red meat
```
57
how much oil should be consumed daily?
low
it should come from fish, nuts, vegetable oils
limit butter (solid fats)
58
keep consumption of saturated fats, trans fats, and sodium...
low
59
how much exercise do adults need? (minimum)
150 minutes of moderate aerobic activity and muscle strengthening activity on 2 or more days of the week
OR
75 minutes of vigorous intensity aerobic activity and muscle strengthening activity on 2 or more days of the week
OR
an equivalent mix of moderated/vigorous activity and muscle strengthening activity on 2 or more days of the week
60
How much exercise should adults get if they want to get the greatest benefit from it?
300 minutes moderate aerobic activity and muscle strengthening activity on 2 or more days of the week
OR
150 minutes of vigorous activity and muscle strengthening activity on 2 or more days of the week
OR
equivalent mix of vigorous/moderate activity and muscle strengthening activity on 2 or more days of the week
61
Benefits of physical activity?
Increase endurance
Increase inner size of arteries
Decrease BP
Decrease blood lipids (HDL)
Lower risk for coronary artery disease and high blood pressure
Increase lung capacity
Greater resistance to fatigue
Burns calories
Improves metabolism
Suppresses appetite
Improves insulin sensitivity
Muscle relaxation
Self-image
Mental release
62
what comprises disease management?
A system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts
are significant
63
When is a disease or condition amendable to disease management?
- significant morbidity/mortality
- numerous lifestyle and therapeutic challenges
- high cost to healthcare system
- multidisciplinary and fragmented approach
- variability in treatment practices
- pt have the potential to be empowered with cognitive and behavioral tools
64
how do pt have the potential to be empowered with cognitive and behavior tools in disease management?
- enhance clinical outcomes
- increase adherence
- reduce system demands
65
describe the stanford self-management program for chronic disease management?
- +20 years
- developed, tested, and evaluated self management programs
- small-group workshops
generally 6 weeks long, meeting once a week for about 2 hours
- led by a pair of lay leaders with health problems of their own
- meetings are highly interactive, focusing on building skills, sharing experiences and support
- Arthritis, Chronic Disease, Positive (HIV), Diabetes
- Spanish, Online
66
benefits of physical activity
Increase endurance
Increase inner size of arteries
Decrease BP
Decrease blood lipids (HDL)
Lower risk for coronary artery disease and high blood pressure
Increase lung capacity
Greater resistance to fatigue
Burns calories
Improves metabolism
Suppresses appetite
Improves insulin sensitivity
Muscle relaxation
Self-image
Mental release
67
what are frustrating problem-centered interactions associated with usual care?
- uninformed passive patient
| - unprepared practice team
68
what are the outcomes of usual care?
suboptimal functional and clinical outcomes
69
what are the downsides of community related to usual care?
no links to community agencies or resources
70
what are the downsides of the health system related to usual care?
- leadership concerned about the bottom line
- incentives favor more frequent and shorter visits
- no organized quality assurance
- patient's problems in managing the illness not solicited or dealt with
- counseling didactic
- care depends on MD in short, unplanned visits
- pt initiated follow-up
- no protocol, specialist input by traditional referral
- pt information limited to chart, no population data
71
essential element of successful chronic disease management
success lies in fostering a pt centered partnership
72
what builds productive interactions in the chronic care model?
informed, active patient and prepared practice team
73
how does the chronic care model address community?
- provides resources and policies
| - builds relationships with healthcare organization and community agencies
74
how does the chronic care model address the healthcare system
healthcare organization
- self management support
- delivery system design
- decision support
- clinical information systems
75
what are the outcomes of the chronic care model?
improved
76
how do community agencies fill gaps in the chronic care model?
- pt education classes
- exercise classes
- smoking cessation programs
- home health services
77
what is the purpose of the delivery system design
- expanded primary care team
- team roles and tasks
- planned interactions
- case management services
- care that understands and fits their culture
- regular follow up
78
what is decision support
- evidence based guidelines
- specialist expertise
- provider education
- guidelines for patients
79
what are the clinical information systems?
- available, accurate timely information
- individual care planning, sharing info with patient
- care reminders
- feedback
80
what is self-management support?
helping people to understand their health behaviors and develop strategies to live as fully, productively, and well as they can
81
what is self-management support?
- assists pt and families with gaining knowledge, skills, & confidence to manage condition
- helps set goals
- provides active support in a partnership role
- helps pt access community resources
82
what are the 5 A's of self-management support
```
arrange
assess
advise
assist
agree
```
83
describe the function of "arrange" from 5 A's of self-management support
specify plan for follow-up (visit, call, mail)
84
describe the function of "assess" from 5 A's of self-management support
beliefs, behavior, & knowledge
85
describe the function of "advise" from 5 A's of self-management support
provide specific information about health risks and benefits of change
86
describe the function of "assist" from 5 A's of self-management support
identify personal barriers, strategies, problem-solving techniques, and social and environmental support
87
describe the function of "agree" from 5 A's of self-management support
collaboratively set goals based on patients interest and confidence in ability to change the behavior
88
What is the personal action plan created by 5 As of self-management support
1. list specific goals in behavioral terms
2. list barriers and strategies to address barriers
3. specify follow-up plan
4. share plan with practice team and pt social supporters
89
what are pt self-management tasks?
- take care of illness (medical management)
- carry out normal activities (role management)
- manage emotional changes (emotional management)
90
what are the 7 characteristics of a self-manager?
- takes responsibility for their health
- forms partnership with provider
- establishes goals, sets action plan, carries these out
- checks results and shares with provider
- explores alternative solutions and makes changes as needed
- asks for help from support network as needed
- committed to living well with a chronic condition
91
describe how self-management support is used to help people
1. understand
2. decide and choose
3. adopt and change behavior
4. overcome barriers
5. cope
6. follow through
92
what ISN'T self-management support
- didactic pt education
- lecturing
- "You should..."
- finger waving
- waiting for pt to ask for help
93
why is self-management support so important
- pt does the vast majority of the work in caring for illness
- self-management support is often ignored
- it is the place where practice team collaborates with pt and caregivers
94
how to provide self-management support
- ask pt to assess unhealthy aspects of lifestyle
- ask about health, concerns, & lifestyle
- identify management areas of concern
- assess readiness to change
- specific plan (goals/action plan)
- check confidence level
- assist with identifying barriers and solutions
- follow up at each visit
95
what are qualities of successful action plans?
- pt wants to do it
- reasonable
- behavior specific
- confidence level >7
- if lower ask what would make it higher
96
describe how to make behavior-specific action plan?
- what will be done
- how much will pt do
- when and where will pt do it
- how often will the pt do it
97
how to address low confidence levels
- identify barries/problems
- brainstorm several solutions
- ask pt if they think any will work
- adjust action plan
- reassess confidence level
98
how does successful chronic illness management differ from usual care?
- support is reinforced at each visit
- care is structured and provided by a team
- close follow up required during periods of poor disease control
- care guided by protocol featuring intensification of therapy
- specialists support primary caregivers
- computer database is a tool for care
