Chronic Disease in my Practice
As a nurse in Hastings and Prince Edward County chronic diseases such as cancer, cardiovascular disease, respiratory disease and diabetes are common in my practice. These diseases are relevant to my practice as they account for 55% of direct and indirect health costs in Ontario (MOHLTC, 2007). What is alarming is that they are not only the most common and costly health problems they are often among the most preventable (MOHLTC, 2007). A small group of modifiable behaviors and biological/risk factors such as physical inactivity, unhealthy diet, tobacco, alcohol consumption, hypertension, high cholesterol and obesity contribute highly to getting a chronic disease (MOHLTC, 2007). Below is a figure depicting risk factors to developing chronic disease.
For all chronic diseases the social determinants of health play a significant role in chronic disease development including income, education, residential segregation, genetic susceptibility, stress, access to health care, social and physical environment and employment (Pleasants, Riley, Mannino, 2016). In Hastings and Prince Edward Counties (HPE) 30% of the population is 60 years of age or older, 1 in 4 individuals earn above $40,000 annually while 1 in 3 people in Ontario make above the same threshold, HPE has 14.8 % low income households compared to 13.9% in Ontario (Hastings Prince Edward Public Health, 2017). It is recognized that lower levels of education are associated with poorer health and HPE has a considerably higher % of people without secondary school 15.4% compared to 10.9% in Ontario (Hastings Prince Edward Public Health, 2017). HPE has a significantly higher number of people who smoke and who are physically inactive or limited in their activity when compared to Ontario (Hastings Prince Edward Public Health, 2017).
HPE has higher rates of hospitalization for cerebrovascular disease, COPD, respiratory disease, lower respiratory disease and stroke than the province (Hastings Prince Edward Public Health, 2017). Rates of COPD are approximately 1.8 times higher in HPE than Ontario, and 1.6 times higher for lower respiratory disease (Hastings and Prince Edward Public Health, 2017). Rates of respiratory disease are 1.3 times higher in HPE than Ontario (Hastings and Prince Edward Public Health, 2017). Rates of cerebrovascular and stroke are approximately 1.2 times the rates observed for Ontario (Hastings and Prince Edward Public Health, 2017).
Obtained from Hastings Prince Edward Public Health 2017 Population Health Assessment.
HPE also has a higher incidence for all malignant cancers approximately 1.1 times that of Ontario (Hastings and Prince Edward Public Health, 2017).
Obtained from Hastings Prince Edward Public Health 2017 Population Health Assessment.
Chronic disease management requires an interprofessional integrated approach with a focus on disease management and prevention (MOHLTC, 2007). Typically care tends to be reactive and responsive to the presenting illness resulting in symptom focus versus patient centered focus in which the individual is empowered to self-manage with appropriate resources and networks in place (MOHLTC, 2007).
Communities and Primary Care is making inroads with chronic disease management with programs such as INSPIRE, Breathworks, diabetic education, community activities, Health Links as well as connections with Family Health Teams and Community Health Centers that offer multidisciplinary coordinated care teams that provide education and system navigation to empower individuals (MOHLTC, 2007).
MOHLTC indicate that all health care organizations within the system have a role to play in chronic disease prevention and management including acute care, primary care, public health, long term care and the government. The role is to champion changes required to shift from reactive care to proactive care and will require leadership, aligned resources, commitment to quality improvement and accountability for outcomes (2007).
References:
Hastings Prince Edward Public Health (2017). Hastings Prince Edward Public Health 2017 Population Health Assessment. Retrieved from http://www.hpepublichealth.ca/sites/default/files/2017_Pop_Health_Assess_Rpt.pdf
Hastings Prince Edward Public Health (2017). The Social Determinants of Health. A Snapshot of Hastings and Prince Edward Counties. Retrieved from http://www.hpepublichealth.ca/sites/default/files/HPEPH-Social_Determinants_Report_Edited.pdf
Ministry of Health and Long Term Care (2007). Preventing and Managing Chronic Disease: Ontario’s Framework. Retrieved from http://www.health.gov.on.ca/en/pro/programs/cdpm/pdf/framework_full.pdf
Pleasants, R. A., Riley, I. L. & Mannino, D. M. (2016). Defining and targeting health disparities in chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease. Vol (11): 2475-2496 doi: 10.2147/COPD.S79077