Chronic disease management

Question 1

What are some good questions to ask about the condition itself?

Answer 1

When and how were you first diagnosed?
What do you understand about your condition?
How have you been at the moment?

Don’t forget to ask about general PMH/DH/SH (smoking, alcohol etc) FH

Question 2

What are some good questions to ask about the management of the condition?

Answer 2

How do you feel you manage your condition?
Establish medication concordance - what they take and when and why they might not
Symptom severity - ie breathless increasing/decreasing? Infection? State of eyes/feet/cardiovascular incidents in DM?

Question 3

What are some good questions to ask about the impact of the condition?

Answer 3

How does your condition affect you in the day to day, work, home, ADLs, activity etc?
Impact on mood/work/sleep/social?
Exacerbations – GP, ED, ITU?
ICE the patient

Question 4

What do you use the data for?

Answer 4

Talk about whatever the data says in a way that makes sense to patient
Provide advice on how to better improve the test results and so management of the disease

Question 5

What is HbA1c and what support is available for diabetes?

Answer 5

HbA1c = long term measure of sugar in your blood and gives us a picture of how well you manage your condition
Diabetic nurses, DESMOND nutritional advice for T2DM - patient education, GP

Question 6

What is peak flow and what support is available for asthmatics?

Answer 6

Peak flow = maximum rate of air flow you can blow out in a forced breath out, gives us an idea of your lung function and so how well you’re managing your condition

GP, asthma review (every year) with asthma nurses, asthma UK website, flu vaccination

Question 7

What is spirometry and what support is available for people with COPD?

Answer 7

Spirometry is how we look at lung function - gives us information about the capacity of your lungs and how its changing so we can see how well you’re managing your condition

GP, pulmonary rehabilitation, British Lung Foundation, Breathe Easy support groups, flu jab

Question 8

What is PSA and what can having a high one mean?

Answer 8

Prostate specific antigen - produced by the prostate gland
Elevated in: hyperplasia, prostatitis, prostate cancer (+ UTI, recent vigorous exercise, ejaculation, anal sex/prostate stimulation, PR examination, biopsy catheter or bladder surgery and some medications (5ARIs ie finasteride) - lots of false positives for cancer!

Doesn’t necessarily mean its cancer, need to do some other tests - biopsy, maybe some scans or other blood tests, physical examination

Also some prostate cancers are so slow growing they’ll never cause you a problem

GP, Prostate Cancer UK, Macmillan Cancer support + nurses

If BPH question: ask about night sweats, weight loss, anorexia, change in bowel habit, bone pain etc and if they’ve had a recent biopsy/cancer screen etc

Question 9

What is an INR and what is warfarin’s role in it?

Answer 9

Measure of how quickly your blood clots - normal range = 2-3, lower = too fast, higher = too slow - need a balance

Anticoagulant record
Dose timings 
Medicine interference 
Food interference 
Side effects 
(see pharmacology)