Chronic Disease Management Framework

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All over the world, there is a primary concern among the healthcare systems that are on the increase about chronic diseases (Shiffman and Smith, 2007). To deal with this challenge, the efforts have been carried out jointly by the World Health organization and the “MacColl Institute for Healthcare Innovation (MIHI) and they have adopted the Chronic Care Model from a world viewpoint (WHO Health Care for Chronic Conditions Team, 2002).

The effort that has resulted from this is the Innovative Care for Chronic Conditions framework (ICCC framework). In setting up the ICCC framework, the World Health organization copied from the CCM – Chronic Care Model which was developed by Wagner together with other people with whom he worked.

This model was expanded to use it particularly in developing nations (Wagner, Austin, and Von Korff, 1996). This framework carries out the expansion of the community and policy features to realize improvement in healthcare for chronic conditions. The framework encompasses components at the patient and family level (micro-level), community-level (meso level) and the policy level (macro-level) (Wagner et al, 2002).

In considering the macro level, the nations are supposed to put in place a policy to be used in realizing prevention and management of chronic conditions. This encompasses high as well as low technology approaches, having the evasion of financing that is fragmented and the motivation schemes that are not aligned; having neither regulation nor monitoring of the standards.

In considering the community or meso level, at this particular level, systems are supposed to be put in place to carry out the management of care over a period of time contrary to acute episodic care. In this, there will be engaging in educating the professionals in the health care sector, giving guidelines that are based on evidence, offering strategies for prevention, putting in place information systems and having a connection with community resources. At a micro level, there is a need for the development of skills among individuals in order for them to prevent chronic diseases and carry out the management of their own health.

The ICCC framework offers a flexible but all-inclusive base and it is on this base that health care systems are supposed to develop or be redesigned in line with the locally available resources as well as local demands (Epping-Jordan et al, 2004).

According to the Australian Primary Health Care Research Institute (2006) report, in recent times, a report was published by the World Health Organization and this move served as a response to the increase in the prevalence of various chronic diseases in the whole world (World Health Organization., 2002).

The main objective of this report in regard to the ICCC framework was to give a description of an all-inclusive world framework for preventing and controlling chronic diseases and this could be applicable to developed nations as well as developing nations. This report pointed out that in most of the nations in the world, health care systems have been built up to handle “acute episodic care”, and this is not suitable for managing and controlling chronic conditions over a long period of time or in the long run.

Davey and Burridge (2009), point out one of the limitations of the ICCC framework. They propose that the ICCC framework can be regarded as being a helpful instrument that can be used to carry out an assessment of a chronic disease program in a particular situation. On the other hand, this framework has particular limitations. For instance, “this framework is narrative and can not set out those indicators that can be appropriate for carrying out quantitative evaluation” (Davey and Burridge, 2009, page 18).

Analysis of the framework in improving the management of chronic diseases in the elderly population

According to Kaneda (2006), in the decades that will follow, there will be a rapid increase in aging among the people in developing countries. Since elderly people are very much prone to chronic diseases, there will be a higher demand for the need to deal with chronic conditions. Kaneda (2006), further points out that it is projected by the World Health Organization that by the year 2015, there will be an increase in the percentage of deaths that result from chronic diseases. This percentage is forecast to be 17 percent.

However, a very small number of developing countries have put in place appropriate programs that encourage healthy lifestyles and prevent chronic diseases. To serve as an encouragement for prevention measures against chronic diseases, the ICCC framework was set up by the World Health Organization. The ICCC framework is targeted at the makers of policies in the health sector.

According to Kaneda, “This framework takes the approach that non-adherence to long-term treatment regimes is fundamentally the failure of health systems to provide appropriate information, support, and ongoing surveillance to reduce the burden of chronic diseases” (Para 6). This framework also offers advice that an approach aimed at prevention can bring down the level of the increasing demand for health care and it can also play a major role in improving the quality of those people who are elderly.

There can be employed of a primary prevention approach even in situations where there might be limited resources and blooming age discrimination. However, unlucky enough, as Peter (2002) point out, “ a negative aging paradigm found both in developed and developing countries assumes that older people’s health needs require high cost, long term treatments” (Page 755).

Those people who criticize this paradigm put it clear that, as on one hand, the elderly people is much more prone to chronic diseases as compared to the young population, there is still substantial room for carrying out the improvement of the health of these elderly people as well as bringing up the level of the quality of their lives by employing interventions that are of low costs in relative terms.

Some of the risk factors are very much known and initiatives can be taken to avoid them. Such factors are associated with unhealthy lifestyle such as smoking and this can be avoided by stopping to smoke. Some of the low cost programs that have been put in place to deal with the problem of chronic diseases include tobacco education program among others. Other primary preventive measures include increasing physical activities and improving the diet.

Chronic disease strategies currently adopted in Australia and the way they relate to national and international chronic disease prevention and management strategies

Good health is very vital in realizing the well being as well as the quality of life of the people of Australia and in other parts of the world in general. Ensuring prevention of ill health and carrying out improvement of the physical health as well as the mental health enables people to take part in a most active manner in the activities of the community and boosts these people’s capacity to live their lives to the full and lives that are productive (Raphael, 2000).

There has been development of the ACT Chronic Disease Strategy (the strategy) in order to offer “an overarching framework for the provision of appropriate programs and supports to address the increasing prevalence of people at risk of, or living with, chronic disease in our community” (Act Health, 2008, page 5).

The ACT Chronic Disease Strategy is set up in a manner to go in line with the “National Chronic Disease Strategy” which was approved by the territories as well as states of the government of Australia in the year 2005 (Commonwealth of Australia, 2010). The “Council of Australian Governments” or COAG made acceptance through the National Reform Agenda to put focus on offering a national framework for heath reform at the local level as well as the national level.

The Council of Australian Governments as well the National Chronic Disease Strategy make a reflection of the picture for health that is undergoing change, making recognition of the rising significance of health promotion as well as chronic disease prevention and taking initiatives together or in partnership at all levels; government level, agencies level, private sector level, public sector level and the at the community level in order to make it possible for people to optimize their health and their well-being and also be able to maintain this (Commonwealth of Australia, 2010).

This strategy offers a framework to undertake work that engages improved management of the chronic disease services that are there and to set up fresh and innovative programs as well as projects targeting to bring down the level of occurrences of chronic diseases or complications of these diseases.

ACT Health carries operations in an entire government environment, capitalizing on opportunities to promote cooperation among departments and collective activities in line with promotion of health and the prevention of the chronic conditions. This strategy makes recognition that the biggest part of what is needed to realize prevention of chronic diseases is dependence on partnerships with a variety of policy areas as well as planning areas that are not within the usual health care system. These areas may include the education sector, housing sector, recreation, town planning sector and even sport sector.

This strategy as well makes recognition of how important it is to focus on the individual while putting in place plans for their care encompassing them as the main and important member of the care players in the team. According to the Australian Department of Health and Ageing (2010), this strategy “has been developed in the context of national Australian Health Initiative (ABHI), a package of Australian, state and territory government activities that focuses on health promotion, disease prevention and management of chronic disease” (page 3).

The impact that is brought in on the mental health is regarded as being of significance. The mental health conditions can as well turn out to be chronic conditions. According to Act Health (2008) “mental health services for the ACT are addressed in the draft Mental Health Services Plan, and therefore will be not be considered specifically in the Strategy”.

In a similar manner, as on one hand cancer can be regarded as a chronic disease, the services associated with this disease are dealt with in the “draft Cancer Services Plan” and thus they will not be dealt with in a specific manner in the Strategy. Yet, there will be a lot in this strategy that will be of relevance for these categories (Epping-Jordan et al, 2004).

Enablers and barriers to achieving “best practice” chronic disease management and prevention in the Australian context

According to Mathers, Vos and Stevenson (1999), “Smoking, poor nutrition, risky alcohol consumption and decreased physical activity (SNAP) are major contributions to the burden of chronic disease in Australia” (Page 53). In the year 2003, the government of Australia set a strategy framework for dealing with SNAP (Smoking, nutrition, alcohol, physical activity (SNAP, 2001).

According to Kalucy, Hann and Whaites (2004), “the 2002 and 2003 Annual survey of divisions of general practice had put in place those programs that put focus on at least one of the SNAP risk factors”. Yet, even if there exist normal programs to deal with chronic conditions like diabetes, there has been no establishment of national SNAP initiative that are specific and no publication of studies of implementation of this in Australia (Smith, Bauman and Bull et al, 2000).

The year 2003 and 2004 saw funding being carried out by NSW Health of a feasibility study to be carried out regarding the issue of the “SNAP approach to behavioral interventions for patients with SNAP risk factor management in one urban and one rural DGP”.(Harris et al, 2005, page 54).

The aims of this study included; having an intention to test the cost of DGP program as well as its feasibility to offer support to practices in order to provide, in a systematic manner, behavioural interventions to those people having SNAP risk factors in general practice. Another aim or objective of the study was to carry out the determination of any variation in the physical capacity as well as self-reported care that is offered by the general practice. The last objective was to carry out the identification of lessons for other divisions for general practice and for carrying out the implementation of the SNAP framework (Whitlock, et al, 2004).

Those people who were involved in the in-depth interviews gave out reports about encountering difficulties in carrying out the organizational changes that were needed to integrate SNAP in to practice in general. It was reported that this problem was partially related to the absence of the practice meetings, conferences (case management conferences), lack of effective communication and absence of teamwork (Harris et al, 2005).

The general practioners were the ones that were majorly engaged in carrying out the implementation of SNAP with the staff that plays the administrative role playing an important part in referrals as well as follow-up. Harris et al (2005) further point out that “even if an opportunity existed for the involvement of the nurses in the program (SNAP), and mostly in the rural division, few changes were carried out in regard to the roles played by the nursing staff” (Page 55).

This came about as a result of the competing demands from other activities. Other barriers were still there and these included having no enough time and the presence of the heavy workload. The intervention of the SNAP called for planning that was practical (Steptoe, Perkins and McKay, 2003).

According to the study that was carried out, “at the practice level, GPs acknowledged a good fit between SNAP interventions and clinical practice, enabling them to incorporate SNAP principles by targeting specific groups of patients or specific risk factors” (Harris et al, 2005 page 56). However, obstacles to program sustainability were such obstacles or barriers as inadequate time within consultations, which are mainly inclined towards the presentation of problems by the patients (Mathews, 2000).

There was limitation on the role that was to be played by the practice staff in the management and implementation of SNAP, having changes being introduced without difficulty being more among the administrative staff as compared to practice nurses, who had roles that were funded directly like immunization among others. Identification was made by divisions of a need to make the communication practice stronger and as well as teamwork and there was also expression of the view that these moves were of great significance in realizing SNAP interventions as well as systems sustainability (Harris et al, 2005).

According to Harris et al (2005) “some of the barriers to implementation may be addressed by facilitating organizational change within and between practices, especially the development of teamwork and linkages” (page 57). This is supposed to be a focus that is specific in nature of Divisions of General Practices, which is supposed to bring in these principles into education programs, quality improvement programs as well as practice accreditation programs (Whitlock et al, 2004)

References

Act Health, 2008, ACT Chronic Disease Strategy, 2008 – 2011.

Australian Department of Health and Ageing, 2010, Australian Better Health Initiative (ABHI). Web.

Australian Primary Health Care Research Institute, 2006, APHCRI Stream Four: A systematic review of chronic disease management

Commonwealth of Australia, 2010, National Chronic Disease Strategy. Web.

Davey G, and Burridge E (2009) Community-Based Control of a Neglected Tropical Disease: The Mossy Foot Treatment and Prevention Association. PLoS Negl Trop Dis 3(5): e424. Web.

Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH (2004) Improving the quality of health care for chronic conditions. Qual Saf Health Care 13: 299–305.

Harris et al, 2005, Implementation of a SNAP intervention in two divisions of general practice: a feasibility study. MJA, Vol. 182, No. 10, 54 -58.

Kalucy, E., Hann, K., and Whaites, L., 2004, Divisions: A matter of balance. Results of 2002 -2003 annual survey of divisions of general practice. Adelaide: Primary Health Care Research and Information Service, Department of General Practice, Flinders University and Australian Government Department of Health and Ageing.

Kaneda, T, 2006, The Shift to prevention. Web.

Mathers, C., Vos, T., and Stevenson, C., The burden of disease and injury in Australia. Canberra: Institute of Health and Welfare (AIHW Cat. No. PHE 17).

Mathews, J., 2000, Health Research to benefit community. Menzies School of Health.,

Peter, L., 2002, Social Policy and Population Ageing: Challenges for North and South, International Journal of Epidemiology 31, no. 4, 754-57.

Raphael, B., A, 2000, Population Health Model for the provision of mental health care. Department of Health and Aged Care. Canberra.

Shiffman J, Smith S (2007) Generation of political priority for global health initiatives: A framework and case study of maternal mortality. Lancet 370: 1370–1379.

Smith, B. J., Bauman, A., E., and Bull, F. C., et al 2000, Promoting physical activity in general practice: a controlled trial of written advice and information materials. Br J Sports Med, 34, 262 – 267.

SNAP, 2001, Smoking, nutrition, alcohol, physical activity (SNAP) framework. Cariberra: Australian Government Department of Health and Ageing.

Steptoe, A., Perkins, L., and McKay, C., 2003, Behavioral counseling to increase the consumption of fruit and vegetables in low income adults: randomized trial. BMJ, 326, 855 – 857.

Wagner E, Austin B, Von Korff M., 1996, Organizing care for patients with chronic illness. Millbank Q. (74):511-544.

Wagner EH, Davis C, Schaefer J, Von Korff M, Austin B (2002) A survey of leading chronic disease management programs: Are they consistent with the literature? J Nurs Care Qual 16: 67–80.

Whitlock, et al, 2004, Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med, 140, 557 – 558.

WHO Health Care for Chronic Conditions Team (2002) Innovative care for chronic conditions: Building blocks for action. Web.

World Health Organization., 2002, Innovative care for chronic conditions: Building blocks for action: Global report. Geneva: World Health Organization. Web.

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Chronic Disease Management Framework

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