Managing Chronic Illness Flashcards
What are the key types of chronic illnesses? (5)
Heart disease Stroke Cancer Diabetes Chronic respiratory disease
What are the shared social and economic determinants for these illnesses? (5)
Poverty Trade agreements Agriculture and transportation policies Capital flows Activities of multinational companies
What are the shared key risk factors for these illnesses? (4)
Tobacco
Diets high in fat, salt, and sugar
Physical inactivity
Harmful alcohol intake
What are the health effects of these illnesses? (4)
Premature deaths and disability
Low productivity
Healthcare costs
Losses in economic growth
How many people have chronic diseases? How many % of GP consultations does this make up, and how many medical emergencies?
15 million people
50%
2/3
In the next 10 years, co-morbidity will increase by how much?
1/3
Define incidence.
Number of new cases of the disease. Generally reported as the number of new cases occurring within a period of time (e.g. per month, per year).
Define prevalence.
A statistical concept referring to the number of cases of a disease that are present in a particular population during a period of time or at a particular date.
What % of chronic illness is cardiovascular disease?
48%
What % of chronic illness is cancer?
21%
What % of chronic illness is respiratory?
12%
What is the most cause of death in the US?
Heart disease (then cancer, then medical error)
What are the risk factors for diabetes? (7)
Social class, age, area and ethnicity
Obesity, physical inactivity and high blood pressure
Compared to white people, people of African origin have less…, but more…?
CHD
More hypertension, diabetes, strokes and renal failure
Compared to white people, South Asians have more…?
Hypertension, diabetes, central obesity and CHD
Asthma is a common chronic condition.
How many people in the UK are receiving treatment for it?
How much is spent by the NHS a year on it?
5.4m people
£1 bn
What is the main cause of physical disability in the UK?
Arthritis
How many people in the UK have arthritis? (How many of these are <45 years old?)
How many % of 70 year olds?
10 million (1 million) 70%
How many % of people in the UK have diabetes? How many of these are diagnosed?
6.2% people in UK (3.3 million diagnosed)
What are the major risks associated with diabetes? (4)
Biggest cause of kidney failure
Leading cause of blindness in adults of working age
Major cause of amputation
Significantly increases risk of cardiovascular disease
How much more are African and Caribbean communities at risk of having a stroke?
Twice as likely
What is the single biggest cause of severe disability in the UK and other developed countries?
Stroke
How many stroke survivors are there in the UK?
1.2 million
How many people a year have their first stroke (England and Wales)?
110,000
What are the risk factors for CVD and CKD? (8)
Social class, age, area, ethnicity
Obesity, physical inactivity, high BP
These put people at risk of diabetes, which puts them at risk of CVD and CKD
How many % of people will experience a mental health problem in their lifetime?
25%
What is the prevalence of depression alone?
What is the prevalence of depression and anxiety?
- 6%
9. 7%
Is depression linked to physical health?
Long term physical conditions increase risk of depression
What are the leading causes of morbidity (DALYs) in England? (8)
Low back and neck pain Ischaemic heart disease CVD COPD Lung cancer Alzheimer’s disease Sense organ disease Depressive disorders
Who are the major users of healthcare services at all adult ages? How much of healthcare spending does this account for?
Adults with multiple chronic conditions
More than two-thirds
How do health systems manage chronic disease? (3)
Level 1 - Self-care and self-management (70-80% of chronic disease population)
Level 2 - Disease management by MDTs (for high risk patients)
Level 3 - Care management (of high risk complex cases)
What are the aims of healthcare for chronic illness? (6)
- Decrease mortality and morbidity through optimum management and prevention of co-morbidities
- Improve patient function and QOL
- Patient actively involved in management
- Doctor-patient partnership and MDT approach
- Enable people to work/live independently
- Cost-effectiveness
What are the modifiable risk factors (57%) for poor QOL with colorectal cancer? (4)
Social functioning Beliefs about disease consequences Ability to maintain normal role Specific symptoms (fatigue, loss of appetite, dyspnoea, depression)
What are the non-modifiable risk factors (57%) for poor QOL with colorectal cancer? (3)
Being female
Multiple co-morbidities
Metastases at diagnosis
Colorectal cancer is the __ most common cancer in men and the __ most common cancer in women.
3rd
2nd
How many colorectal cancer diagnoses are there a year? How many deaths per year?
> 40,000
>16,000
5 year survival rates for colorectal cancer have increased since 1970s - by how much?
Doubled
What does diet and exercise help with for colorectal cancer?
Fatigue, diarrhoea, nausea & vomiting, loss of appetite, anorexia & cachexia, psychological functioning, general physical functioning
What do self-management interventions help with for colorectal cancer?
Pain, breathlessness
What do nurse-led interventions help with for colorectal cancer?
Fatigue, breathlessness, nausea & vomiting, pain, psychological functioning
What do behavioural/counselling interventions help with for colorectal cancer?
Fatigue, pain, bowel problems, nausea & vomiting, breathlessness and psychological functioning
What approach offered most promise for colorectal cancer over the medium to long term?
Psychological approaches
International Classification of Functioning, Disability and Health integrates medical and social models - it recognises the significance of environment and focuses on components of health rather than consequences of disease.
What are the three domains that make up the ICF?
Body function and structure (impairment)
Activities (limitation)
Participation (restriction)
ICD defines the universe of disease, disorders, injuries and other related health conditions.
What are the benefits of ICD? (4)
Comprehensive
Hierarchical
Easy storage, retrieval and analysis for evidenced-based decision-making
Sharing and comparing health information between hospitals, regions, settings and countries OR across time
Define impairment.
A body lacking part or all of a limb, or having a defective limb or other bodily mechanism. An injury, illness, or congenital condition that causes or is likely to cause a loss or difference of physiological or psychological function.
Define disability.
The many social and other disadvantages imposed by society on people with physical impairments. The loss or limitation of opportunities to take part in society on an equal level with others due to social and environmental barriers.
Define illness.
A patient’s interpretation of his or her disease, the feelings that accompany it, the life events it turns into.
What do chronic illness affect? (3)
Practical aspects of everyday living
Planning for the future
Social relationships and family life
What is meant by biographical disruption?
When people develop a chronic illness e.g. rheumatoid arthritis the map they have of their lives (their biography) is disrupted. This has consequences at the practical and social level. The illness will have significance for a person’s identity.
Serious chronic illness may lead to ‘loss of self’ - what does this mean? (4)
Restricted lives
Social isolation
Being discredited
Burdening others
How do the agendas of doctors and patients differ?
Doctor – interested in explaining the aetiology of the disease
Patient – trying to make sense of the disruption caused by the disease
What are the management challenges for doctors? (6)
Non-adherence Lifestyle change Burden of treatment for patient Communicating with patients Co-morbidities Co-ordination of health care
What are the prevention challenges for doctors? (6)
Lifestyle change Exercise Diet Smoking Communication Self-management
List some policy documents/frameworks.
National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care
NHS Outcomes Framework: at-a-glance. List of outcomes and indicators in the NHS Outcomes.
Government policy: long term health conditions.
A mandate from the Government to the NHS Commissioning Board
No decision about me, without me. 2012.
What is the cycle of deliberative inquiry?
This is a cyclical process focused on producing and utilising insights.
Deliberative issue analysis -> convening -> facilitating deliberative engagement -> reporting -> back to the beginning
Action is in the middle. Reporting and facilitating deliberative engagement-> action, and action goes to deliberative issue analysis.
What are obstacles to deliberative engagement? (4)
Rely on wishful thinking
Magic bullets
Devil figures/scapegoats
Paradox splitting
