The question was posed in our Master of Health Studies unit on chronic disease, which chronic diseases are relevant to your practice and at what rate? I was tempted to respond: all of them and 100%! However to be sure, I needed to find a definition of chronic disease. Alberta Health Services provides a straight-forward definition: “(if) you live with a health condition that requires ongoing management, (this is) called a chronic health condition and (can) include things like diabetes, obesity, high blood pressure and some cancers.” While clients from all of the diagnosis groups included in this definition frequently access Home Care services, those who require ongoing support services due to disability are the clients with whom I most typically work directly. Do these clients have a chronic disease? Consider a client with Multiple Sclerosis. It is certainly both a disease, and chronic, and it requires ongoing management, so that would seem to qualify. Similarly, Parkinson’s, dementia, inclusion body myocitis, progressive supranuclear palsy, multi-systems atrophy, amyotrophic lateral sclerosis, muscular dystrophy are all supported through our home care team. It seems as though all these progressive neurological conditions are once again, diseases that are chronic and require ongoing management.
Oddly, however, when looking at this broad category, I came across many resources that had a short list of conditions that are considered “chronic disease”, most typically heart disease, hypertension, cancer, diabetes, obesity, COPD and arthritis. Clients with these conditions often do end up on home care, but I did not understand why those conditions most commonly found on my team’s caseload were not included in most descriptions of chronic disease. After all, some of the definitions I found certainly were descriptive of my clients. Warshaw (2006) defined chronic disease as “conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living”. Check, check and check.
The Australian Institute of Health and Welfare describes the following features of chronic disease:
- complex causality, with multiple factors leading to their onset
- a long development period, for which there may be no symptoms
- a prolonged course of illness, perhaps leading to other health complications
- associated functional impairment or disability. (n.d.)
Four for four! This definition certainly describes most of the clients on my caseload. Why are my clients not getting equal billing?
I kept reading. I learned things that I already had some awareness of – the most common chronic diseases are very common, indeed. Alberta Health Services (n.d.) tells us that in 2012, 735,000 Albertans had one or more of hypertension, COPD, and coronary artery disease and that these clients were responsible for $4.5 billion in healthcare expenditures in the province in 2012 alone. Of interest, these diseases that I kept running across in the definitions happen to be the most common, and may also be the most amenable to change.
This led me to resources on chronic disease management. Health Education and Self-Management are central tenets in supporting clients through the management of their chronic conditions. Many of my classmates provided interesting posts on how health behaviors and associated conditions impact the health system, as well as how these conditions might be addressed:
(Rose & Oliveros, 2018)
(Butland & Salt, 2018)
Alberta Health Services has a collection of education, support and services under the title “Alberta Healthy Living Program” intended to help those with chronic disease manage their condition and improve their health. The services provided include education on areas such as heart health, emotional health, and managing weight and diabetes. Exercise planning and programs are available, as well as courses on self-management of health.
All of these areas of support are certainly relevant to the clients on our team’s caseload – those with progressive neurological conditions – but their conditions are perhaps less likely to show significant improvement with these interventions. Perhaps all the conditions discussed here are chronic disease, but they can be separated into two broad categories: those conditions where changes in health behaviors have the potential to have significant impact, and those conditions where these changes would have minimal impact on disease progression.
Does that mean we should not apply some of the principles of chronic disease management in supporting home care clients with chronic, progressive, disabling conditions? I recently had a conversation with my colleague and classmate, Andrea Goldstein, Physical Therapist, about vulnerable populations and chronic disease. We spoke about seniors and adults with permanent or progressive disabilities. Both of these groups, by way of their isolation and risk of reduced access to health services, can be considered vulnerable populations. Andrea described a situation where a discussion was had about access to a rehabilitation program. The view was expressed that the program should accept only those within their target population who were most capable and likely to succeed – those without associated chronic conditions or disabilities. Andrea and I agreed, this seems antithetical to one of the central tenets of good rehabilitative care, and good health care, in general – to meet the client where they are. It would seem to offer a call to action for those of us working with these vulnerable populations having chronic diseases and conditions, to determine ways to include all our clients to realize the potential benefits of chronic disease management.
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References
About chronic disease. Retrieved November 19, 2018 from https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/about
Alberta healthy living program. Retrieved November 5, 2018 from https://www.albertahealthservices.ca/info/page13984.aspx
Alberta healthy living program - Calgary Zone. Retrieved November 5, 2018 from https://www.albertahealthservices.ca/findhealth/Service.aspx?id=1005671
Butland, W. & Salt, N., Diabetes Mellitus (D.M.): Alberta vs. Ontario (2018). Retrieved November 19, 2018 from https://sway.office.com/gaTA2TeA204JK3MZ?ref=email
Chronic disease management. Retrieved November 5, 2018 from https://www.albertahealthservices.ca/info/page11934.aspx
Chronic disease management. Retrieved November 18, 2018 from https://www.albertahealthservices.ca/info/page11934.aspx
Rose, A. & Oliveros, S., Tobacco Use-Alberta and Ontario (2018). Retrieved November 19, 2018 from https://sway.office.com/1kdYEyp3a6zowogc?ref=Link&loc=play
Waisel, D. B. (2013). Vulnerable populations in healthcare. Current Opinion in Anaesthesiology, 26(2), 186-192. doi:10.1097/ACO.0b013e32835e8c17