Chronic Illness frameworks and Primary Care Physiotherapy

Editor's Notes

• #3: Chronic diseases account for two thirds of emergency medical admissions to hospitals. 60% of hospital bed days are related to chronic diseases and their complications Increases with age Higher in males (except diabetes) Higher in lower socio-economic classes Nearly 1.25 million adults aged 16 years and over have hypertension Overall increased prevalence of chronic illnesses projected is projected to be 40%
• #4: reforms that ensure that health systems contribute to health equity, social justice and the end of exclusion, primarily by moving towards universal access and social health protection – universal coverage reforms reforms that reorganize health services as primary care, i.e. around people’s needs and expectations, so as to make them more socially relevant and more responsive to the changing world while producing better outcomes – service delivery reforms; reforms that secure healthier communities, by integrating public-health actions with primary care and by pursuing healthy public policies across sectors – public policy reforms; reforms that replace disproportionate reliance on command and control on one hand, and laissez-faire disengagement of the state on the other, by the inclusive, participatory, negotiation-based leadership required by the complexity of contemporary health systems – leadership reforms. Health Inequality: the substantial progress in health over recent decades has been deeply unequal, with convergence towards improved health in a large part of the world, but at the same time, with a considerable number of countries increasingly lagging behind or losing ground. Furthermore, there is now ample documentation – not available 30 years ago – of considerable and often growing health inequalities within countries. Changing health problems: the nature of health problems is changing in ways that were only partially anticipated, and at a rate that was wholly unexpected. Ageing and the effects of ill-managed urbanization and globalization accelerate worldwide transmission of communicable diseases, and increase the burden of chronic and noncommunicable disorders. The growing reality that many individuals present with complex symptoms and multiple illnesses challenges service delivery to develop more integrated and comprehensive case management. Inflexibility of current system: the responses of the health sector to the changing world have been inadequate and naïve. Inadequate, insofar as they not only fail to anticipate, but also to respond appropriately: too often with too little, too late or too much in the wrong place. eg aging population, obesity epidemic. cancers, diabetes and heart diseases worldwide are currently preventable and prevention is cost-effective. This group of chronic conditions is not only associated with high levels of mortality, but also long-term disability and morbidity. Community participation in physiotherapy led primary healthcare initiatives such as screening programs will help prevent this PHC encourages an integrated approach to healthcare and prevention PHC emphasizes community participation
• #6: What is the irish government doing?
• #7: highlight youtube video as a resource
• #9: Summary of literature on PA and health Model of best practice for inclusion of PA pathways in health care setting. Outlines roles and responsibilities, competencies and training of the referring practitioners and service providers. Recent findings have indicated the need for a new national framework for exercise referral. Offers huge opportunity to be a key participate in the delivery of future health interventions Ex referral=1 pathway that exists in health care setting. How? ex ref to quality, safe and effective supervised pa opportunities. develop knowledge of hcps in relation to pa and its role for primary prevention for individuals with CI. Target Population: 3 categories of patients. 1=moderate to severe NCDs impacting on QoL 2=definite but mild NCDs, not yet impacting 3= inactive, sedentary, at risk of developing
• #10: Must understand: NERF protocols +procedures, benefits + risks of PA, MI training. Physiotherapists are an important influence of patient behaviour and key initiators of NCD prevention actions within HC system Ref Practitioner: Recruit, determine suitability, benefits to pa, ER- intermediary role: matches, also gives advice to referring practitioners. MI training to determine the patient's stage of behaviour change. review. E- Learning training module is recommended. Available to those working in HSE or as CPD. ERU-Provide medical, exercise specific and behaviour change expertise to referring practitioners. Cat B: BSc honours degree in exercise science, NCD management or a related topic and for Cat A: MSc.
• #11: Obesity in itself represents a major chronic illness but is also a major contributor to other chronic illness’s. It has been highlighted as a government priority in addressing the determinants of chronic illness. This framework was evidence based on NICE, WHO and The National Taskforce on Obesity 2005 etc.
• #12: *communication aim *working with other sectors pre screening etc is in an ideal world..not feasible with the current service that exists
• #13: The prevalence of obesity in Ireland is a consequence of multiple determinants. Intra personal, Inter personal, (Family & Psychological), Environmental. This is the evidence of the determinants of obesity from the taskforce which we have discussed in detail in college.
• #14: As physiotherapists in the primary care setting we have the ability to influence many of these determinants through education and effective communication. *primary care is the future