Chronic Illness Flashcards
% of Canadiens living with chronic illness?
33% (1/3)
62% of death is due to: (4)
COPD, Diabetes, Cancer and Heart disease
People with comorbidities greater risk of?
a. Adverse health outcomes
b. Higher hospitalization
c. Higher health care needs
Highest palliative care cost is in which setting?
Acute care settings
Phase of Illness:
- Crisis
- Chronic (long-haul–> is really long, it depend)
- Terminal
Distinguishing Chronic disease vs Chronic Illness? Chronic Disease:
- Long duration and generally of slow progression.
- No definite cure
- Gradual change over time
- Asynchronous evolution
Distinguishing Chronic disease vs Chronic Illness? Chronic illness:
- Lived experience of long-term disturbance, symptoms, condition or disorders
- How people cope with it
- Includes phenomena such as fatigue, pain, confusion, and/or stigma
Contributing factors:
Non-modificable risk factors (eg. genetic)
Behavioral risk factors (eg. smoking, diet)
Cultural and environmental condition (eg. work environment)
Intermediate condition leading to disease endpoints:
HBP
Hyperlipidemia
Obesity
Pre-diabetes
% of Canadians aged 20 and older currently have a chronic disease?
60%
Wagner’s Chronic Care Model, the 6 keys elements:
- Delivery System Design: how primary health care is organized
- Decisional Support
- Clinical Information Systems: innovative ways to store and access patient information
- Community Ressources and Policies (eg. existing self-management program within the community)
- Health Care Organization: from a reactive to a proactive system
- Self-Management
To have the best functional and clinical outcomes, as the Wagner’s Chronic Care Model is presented, the 6 keys elements need to be related to and interacting with:
- Informed, activated patient (if the patient is not motivated, they fell worse than people that are active)
- Prepared, proactive active team
(BOTH together –> to have a productive interaction)
The Expanded Chronic Care Model is
- Wagner + Alma Ata
- Include build healthy policy, create supportive environments, strengthen community action, develop personal skills and Reorient health services.
- Population Health Outcomes/functional and clinical outcomes
The chronic Illness Measurement framework is
- Framework to improve the chronic illness experience across the illness trajectory.
- Autor: Loiselle
- Include 4 perspectives: Patient perspective, family perspective, patient/family shared perspective, interactions with the healthcare system
- We often forget certain aspect of chronic illness (eg. pt with cancer could be okay but bc of healthcare system, get worried bc do not receive his result)
The chronic Illness Measurement framework: The Patient Experience
Patient-reported outcomes
Patient engagement/activation
The chronic Illness Measurement framework: The Family Experience
(how the family is resilient, how they reacting to this situation)
Family-reported outcomes
Family engagement/activation
The chronic Illness Measurement framework: The Patient/Family Experience
(Relation of empowerment, how well they feel they are equipped)
Pt/Family reported outcomes
Pt/Family engagement/activation
The Family Systems-Illness Model is
Look at the family system model perspective (values/paradigm, transgenerational/history/illness/loss/crisis, affective style, development individually or as family, instrumental style such as cohesion, adaptability, communication)
Autor: Rolland
Difference between the Family Systems-Illness Model of Rolland and the Chronic Illness Measurement framework of Loiselle?
Rolland have look at the family system model perspective and Loiselle improving patient experience.
The Chronic Illness Measurement framework: Interactions with the Health Care System
Structure, care processes, utilization and access, and satisfaction
Self-management Models in Chronic Illness:
- Stanford’s Chronic Disease Self Management Program (CDSMP) developed by Kate Lorig.
- Improved self-efficacy, reduced pain and fatigue, enhanced positive health behaviors.
The Patient Activation Measure (PAM): 4 levels
Level 1: Disengaged and overwhelmed
Level 2: Becoming aware, but still struggling
Level 3: Taking Action
Level 4: Maintaining behaviors and pushing further
Level 1: Disengaged and overwhelmed
- Individuals are passive and lack confidence.
- Knowledge is low, goal-orientation is weak, and adherence is poor.
- Their perspective: Doctor is in charge of my health.
Level 2: Becoming aware, but still struggling
- Individuals have some knowledge, but large gaps remain.
- They believe health is largely out of their control, but can set simple goals.
- Their perspective: I could be doing more.
Level 3: Taking Action
- Individuals have the key facts and are building self-management skills.
- They strive for best practice behaviors, and are goals-oriented.
- Their perspective: I’m part of my health care team
- eg. I will exercise to lower my blood sugar.
Stanford program and others program for chronic disease depend on:
Where they are, they are different between provinces, between country.
Wagner’s Chronic Care Model is
- Wagner argue that many chronically sick patients are not receiving adequate long-term care
- This type of primary care needs to be redesigned to cope with long-term, incurable conditions.
- Wagner’s revision aimed to support patients in self-management of their condition by enhancing their own skills; this required engaging a broader team that includes links with community care agencies, tracking systems to monitor patient progress, and delegation of the central organizational role from physician to a case manager.
Innovation in Chronic Illness:
E-health (internet heath) M-Health (mobil health) Connected health (both E-health and M-health)
