Discussion
Asthma has been a global problem, affecting more than 300 million of all ages. New Zealand has been a higher prevalence of asthma, with one in seven adults (Hales etal.,2021). There has been a significant connection between asthma and anxiety in New Zealand. Bedolla-Barajas et al. (2021), reported that asthma and anxiety has been a significant due to limited knowledge regarding the asthma control, frequent wheezing and difficulties breathing during the asthma attack. On the other hand, congestion, wheezing even defeated, stress associated with asthma resulted in anxiety (Baggott et al., 2020). Population living in New Zealand are at higher risk of asthma due to racial discrimination, limited accessibility of care, poor availability of traditional care. Therefore, mental disorder was generally higher among those affected by asthma compared to healthy individuals. Female are at higher risk of developing such co-morbid situation limited knowledge of asthma triggers, changes in the hormonal fluctuation, easily activated and longer-acting fight-or-flight (Bláfoss et al.,2019). Therefore, it is crucial for the individuals to gain control of their illness, manage sudden triggers and improve quality of life. Personal centered care is fundamental in this case in order to improve quality of care. Person centered care usually promote better health outcomes, focus more on empowerment and heard and valued- better concordance (Pereira et al.,2019). The paper aims to discuss workload, capacity and impact of this group on the access care, use care and self-manage. Cumulative complexity model will be used for discussing workload, capacity and impact on the population (Stevenson & Leis, 2018). Secondly, person centered coordinated, minimally disruptive medicine and purposeful shared decision making will be discussed. Lastly, the paper will summarize the paper to provide an insight into the journey of the women with co-existing asthma and anxiety.
Asthma is the most common chronic illness which affect more than thousands of individuals around the globe. Asthma is defined as the respiratory condition which resulted in airway inflammation, narrowed and chest pain. The common symptoms of the asthma are breathing difficulties, chest pain and cough and wheezing, trouble sleeping, chest pain and early actions (Krings et al.,2019). New Zealand tend to have higher level of anxiety and asthma , especially amongst women which resulted from exposure to house dust (house dust mite allergen) and recognised as the country with higher level of house dust mite allergen (Beasley et al., 2020). Informative sheet regarding house dust mites suggested that approximately 70 to 80% asthma of New Zealand are directly associated with allergies where most common allergies are resulted from faecal waste developed by house mites. However, population tend to have higher level of anxiety while diagnosed with asthma due to limited knowledge regarding the asthma control, frequent wheezing and difficulties breathing during the asthma attack. In this case, cumulative complexity model will be discussed in order to improve the treatment accessibility.
Cumulative complexity model
Cumulative complexity model usually integrates existing literature and emphasizes on the patient-centered framework (Tonelli et al.,2018). This model is able to emphasis patient level mechanism by emphasizing clinical and social factors that complicate patient care. The following will focus on Cumulative complexity model to discuss the population such as women with anxiety and asthma.
Theoretical framework for obtaining an overview of multiple chronic health issues of an individual at same point of time have emerged. Cumulative complex model can thus be considered effective in terms of understanding the balance between asthma patients’ workload and their capacity. Thus, it might be easier for the healthcare service providers to identify the gap in patients’ care (Mindlis et al., 2021).
New Zealand tend to have higher burden compared to other countries. The treatment burden for the population primarily developed from limited accessibility of medication (salbutamol) , fears around the intensive treatment. Other factors that increase the treatment burden are limited transportation, poor health care literacy and low awareness regarding community support groups (Trnka, 2018). Therefore, treatments burden are tend to be higher amongst population. Inequitable Maori health outcome for the women with anxiety and asthma are consistent with the indigenous experience of colonisation and social exclusion. Cooley et al. (2020), reported that low availability of information resources regarding indoor environmental exposures and sensitization for women tend to increase their anxiety triggers and reduce their ability to manage personal health care system. In New Zealand, Maori population and pacific Islander women with anxiety tend to have low access to supportive technology for monitoring wheezing ,changes in hormone and triggers that can further increase asthma episodes which reflected in higher level anxiety amongst compared to male population (Pignataro et al.,2020). The women tend to receive limited traditional services regarding asthma and anxiety together as majority of the asthma support services are developed for the population are developed for either asthma or anxiety (Trnka, 2018). The lack of cultural sensitivity amongst non-indigenous health care professionals and low gender species another factors that further increase treatment burden.
Considering the clinical outcomes associated with asthma, it can be expected that this chronic respiratory issue is responsible for impacting the lifestyle of individuals. First of all, asthma attack can be triggered at any point of time as the person is exposed to the allergens and in such cases prompt medical action is required to address the issue. In such situation, getting emergency appointments with the doctors might become an issue for which health complications of the patients might get worsened too. As a result of this, activities of daily life might get impacted and individuals may experience life burden due to their illness. Another important aspect that must be included in this discussion is cost of asthma treatment.
Treatment burden
According to the research conducted by it has been indicated that majority of individuals who have been diagnosed with asthma reside in either low or in middle income countries. In these countries, people are more likely to suffer from asthma-related morbidities at a disproportionate rate. As a result, the mortality rate for the disease is also high in these countries and can be held responsible for increase in disease burden. Considering the situation, it has been evidenced that the medications and other interventions for asthma are of high demand. This increasing demand for asthma treatment can also be held responsible for unavailability or unaffordability by a group of people especially who belong to lower socio- economic status. Medications which are essential for asthma patients, particularly those drugs containing inhaled corticosteroids (ICS), are frequently become costly or unavailable for people who are in need of these medicines. This might also create an imbalance between the workload and capacity components in the context of provision of care and thus use of care might get interrupted.
Several studies investigated at the association with both asthma and other chronic disorders; the research indicate that having depression, anxiety, or panic disorder is linked to a higher likelihood of acquiring asthma diagnosis and poorer asthma outcomes. Furthermore, the findings of these studies showed that having asthma is linked to a higher chance of obtaining a new depression, anxiety, or panic disorder diagnosis. These comorbidities might be responsible for impacting access of care by individuals and might contribute to life burdens for the women who have been diagnosed with this critical respiratory illness.
In New Zealand women who had been diagnosed with asthma and anxiety at the same time might encounter transportation problem depending on the remoteness of their residential area. It has been evidenced by several studies that individuals often deprived of high-quality healthcare support due to remoteness and unavailability of efficient healthcare volunteers in the remote region and thus it needs to be addressed. On the other hand, it has also been interlinked that death of loved ones might also be a significant life burden which may impact almost 22% access of care.
Use of care might be correlated with competing among the priorities in life. There might be some workplace related issues which might disturb the pattern of using available care for asthma as well. For example, there are working fields which demands extra hours of work from their employees. In case one of the female employees who have been diagnosed with asthma and is under treatment, might find it difficult to have the medications on time. Sleep cycle of the person might get interrupted due to long working hours. Eventually the patient might become treatment non- compliant which might increase the risk of asthma exacerbation. Similarly, fear of losing job while using care properly, might also exaggerate anxiety issues among the women.
Access to care
There is a major aspect which comes under life burden and might make it difficult for women to self- manage their condition. Growing older is the issue which might be interconnected with having no health insurance, limited pension amount and lifestyle changes which might impact self- management of care. Loosing dignity at the older age might also concern the health of the individuals. Thus, the workload will be increased leading to limited capacity of the individual.
Illness burden is one of the factors which might be regarded as highly important for the female patients who are the suffers of asthma as well as anxiety. Availability of supporting network, financial status of individuals, level of disability caused by chronic illnesses like asthma and multimorbidity, anxiety and fear regarding current illness might be considered as the barriers in accessing appropriate care for asthma among the patients.
Using care facilities might be correlated with illness burden for this particular group of asthma patients due to their compromised activities of daily life. It has been extensively evidenced that asthma might impact the activities of daily life of individuals by limiting their activity tolerance level and mobility status. As a result, these patients might feel exhausted or may have mood disorders in response to asthma’s symptoms. Thus, proper use of care might not be possible by them. Community and social support being a significant aspect of individuals’ life, the fear of being alone due to illness might prevent individuals to optimise the use of care. Examples might include missing appointments with doctors, being treatment non- complaints, pursuing smoking and alcoholism to retain social interactions. It has been estimated that 16% of women living with asthma and anxiety display the fear of feeling along while using the care for their treatment. Multiple co- morbid factors may also disturb the balance between workload and capacity by impacting use of care among these patients.
A rapid increase in intrathoracic or intra-abdominal pressure can result in retinal haemorrhage, which can cause abrupt and severe vision loss. Thus, asthma patients are susceptible to vision loss which might prevent them to self- manage their health conditions effectively. Besides, the symptoms related with asthma and anxiety may also include breathlessness, impaired mobility status, decreased cognitive functions, depression, sleep disorders, loss of strength and impaired speech. All of the above- mentioned clinical problems might be held responsible for impacting the self- management ability of the women who are living with asthma and anxiety.
Comorbidities and mental health
There is a wide range of resources which might be implied for optimising the accessibility of care, using the care options and ensuring self- management of asthma and anxiety among the women. Implications of these might ensure balancing between the workload and capacity and thereby might lead to a positive outcome as indicated in the cumulative complex model. The resource scarcity may be present at personal, physical, mental, cultural and even in the social level. For example, for women who belong to poor socioeconomic level might not be able to bear the cost of treatment which might become a barrier for care optimization for individuals. There are evidences which indicated that most of the women from the rural arreas have to come to the town hospitals since they do not have physical access to health services or might lack advance healthcare equipment which might effectively tackle complex clinical situations. People from different cultural background reside in New Zealand. However, in case interpreters are not available for ESOL, for explaining the test results or for the doctors, patients might experience linguistic challenge in understanding their problem. As a result, use of care might get impacted. Resource scarcity may also be seen in availability of flight staffs who might transfer the patients to advance healthcare organizations for emergency treatment and thus patients may experience delay in treatment which might again can be correlated as a challenge in accessibility of care. The risk of cardiovascular emergency such as stroke is also high among the asthma and anxiety patients. However, every people or every town might not have access to the Stroke Foundation which provide emergency services to individuals. In that case, accessibility of care will be questioned for the chosen group of population. In such cases, patients need to be admitted in hospitals for days for proper management of their condition. During this period, people may feel alone being away from family and might not participate or use the care optimally. These are the areas which need to be rectified with appropriate interventions so that asthma patients might get equally accessibility of care, they can use care optimally and might self- manage their condition.
New Zealand tend to have higher burden compared to other countries. Women with anxiety and asthma have higher burden of treatment burden with lower level of access to the treatment, risk of misdiagnosis (Agusti et al.,2021). In this context, person centred collaborative care, Purposeful Shared Decision making and Minimally Disruptive Medicine are suitable for improving their personal journey of purposeful live. For example,PCCC improve journey and support the recovery by including families in the decision making in terms of taking salbutamol and other psychotherapies related to anxiety. On the other hand, Minimally Disruptive Medicine enable them to improve understand of treatment, build relationship with the families, improve readmission (Scott et al.,2021). Person centred collaborative care and Purposeful Shared Decision making together can support female with anxiety and asthma to improve quality of life by assessing holistic aspects of wellbeing such as social, spiritual and mental health needs of the patients. The following will discuss each components of improve the journey of the patients with complex disease.
Person-centered care
It is common instances where majority of asthma care have limited consideration of female with anxiety and asthma (Maltby et al., 2021).In New Zealand, mainstream service providers exhibited limited involvement of the family members ( Whanua) which reflected in their low involvement in the health care setting. Since health perception of the women with anxiety and asthma are shaped by the families, culture, limited knowledge regarding the asthma control, frequent wheezing aggravated the physical and mental health. It also reduce ability of the population control episodes. In this case, Person centred collaborative care can be used by involving multidisciplinary team, especially pulmonologist and psychotherapist. In this case, family members ( Whanua) can be involved in care in the partnership in order to improve shared decision making. For Maori population, cultural liaison officer will be involved along with family members because Maori population tend to have language barriers and cultural barriers that may limit their communication regarding appropriate allergic triggers, anxiety symptom (Violette et al., 2021). Provision of the collaborative care by involving cultural liaison officer will improve therapeutic relationship of Multidisciplinary with New Zealander (T?ngata Aotearoa).Therefore, families able to exercise their autonomy regarding collective decision making, able to clarify their issues regarding co existing conditions, especially women. For example, population often encounter challenges in regarding decision making in terms of time constraints, lack of applicability of the information. In this case educational or up to date information as a part of the collaborative care will provide the population with an opportunities to understand the complexities of co-existing disorder, how they will be addressed using shared goal setting (Maltby et al.,2021). The collaborative care also improve time constraints and application of the resources to improve referral services of asthma and anxiety, especially psychotherapies associated with anxiety ( Cognitive behavioral therapy with the assistance of traditional culture ) (Yohannes, Newman, & Kunik, 2019).The similar strategies can be used for Pacific peoples. They also experience limitation regarding collective decision making due to language barriers and cultural barriers. This care also support Pacific peoples to improve their inclination
While mainstream professionals may find it challenging to support women with anxiety and asthma due to gender based biases and cultural limitation,collaboration enable them to understand cultural values that can be implemented in combination with salbutamol and psychotherapies, non-pharmacological interventions and perceived clinical barriers (Hardy et al.,2020). It can make difference in the journey of recovery and understanding triggers because it enable patients and their families gain control of their illness, confidence in rehab process of anxiety and asthma, helps to reinvent their role to support their families. In this case, it will also support their satisfaction with problem resolution. As discussed above, 70 to 80% asthma of New Zealand are directly associated with allergies where most common allergies (Brick et al.,2020). The collaborative care enable professionals and families to be aware of distinct allergies associate with asthma and how the triggers can be minimised. The families in this case can take active part in cleaning allergies so that allergies can be reduced. It will also enable families to encourage the women to exercise their autonomy (Tackett et al.,2021). Families will specifically enable the target group to reduce self-stigma through structuring of the family routine, having available resources in New Zealand to support their fosters effective problem-solving (Alzaye et al.,2019).
Conclusion
Purposeful Shared Decision can be combined with Person centred collaborative care because it enable professionals to encourage new Zealanders to ensure diagnostic tests ,self-management and medications to improve their patient care (Tackett et al.,2021). As discussed that population tend to experience higher level of exclusion from the treatment which limit their understanding of asthma. Many women unable to involve in appropriate disclosure regarding their lived experience of asthma due to stigma (Yohannes, Newman, & Kunik, 2019). Therefore, the lack of limited purposeful decision making to address effective problem-solving. The purposeful decision making enable the families to actively involved in the treatment goal and objective so that their decision making can be recognized (Tackett et al.,2021). This decision making enable them to improve empowerment and autonomy, having their voice to be integrate part of the care. It will also improve health outcome because many people able to take responsibility of the health.
Minimally Disruptive Medicine can also support female with anxiety and asthma because it is context-sensitive approach that enable professionals to achieving their goals for life (Australian Family Physician, 2022). New Zealanders often unable to consider the pharmacological interventions due to limited awareness and contradiction and faith on the traditional medicine. Minimally Disruptive Medicine is specifically suitable for New Zealander female with anxiety and asthma because it is able to reduce imposing the smallest possible treatment burden on their lives. In this case, female with anxiety and asthma can be supported MDM so that their personal goal of care can be aligned with personal goals (Australian Family Physician, 2022). It is also enable population to avoid unnecessary procedures and side effects. Salbutamol usually have side effects headache, sore throat and cough, feeling nervous (Kearns et al.,2016). On the other hand, Salbutamol often also increase the heart rate by myocardial oxygen demand. In this case, population tend to exhibit lower level of adherence due to such side effects or lack of access to psychotherapies. Such support can improve their medication adherence , use of inhalers. Moreover, it can also reduce the misdiagnosis, minimise appointments and reduce treatment burden. In this case, it will reduce decrease in treatment burden, reduced treatment cost for patient and the services (Kearns et al.,2016). On the other hand, as discussed above, 1 in 8 adults in new Zealanders have asthma while majority of them are women and they have anxiety due to easily activated and longer-acting fight-or-flight. This medicine improve the pharmacological support for the Women with anxiety and asthma while reduce and improve better understanding of patient choice. Hence these three components of the care will improve journey of women who failed to disclosure their anxiety while diagnosed with asthma.
Conclusion:
On a concluding note, Asthma is the most common chronic illness which affect more than thousands of individuals around the globe. Female are at higher risk of developing such co-morbid situation limited knowledge of asthma triggers, changes in the hormonal fluctuation. Treatment burden are higher for the population due to misdiagnosis, limited technological support. The collaborative care enable professionals and families to be aware of distinct allergies associate with asthma and how the triggers can be minimised. The families in this case can take active part in cleaning allergies so that allergies can be reduced.PCCC improve journey and support the recovery by including families in the decision making in terms of taking salbutamol and other psychotherapies related to anxiety. Minimally Disruptive Medicine is specifically suitable for New Zealander female with anxiety and asthma because it is able to reduce imposing the smallest possible treatment burden on their lives. On the other hand, families will specifically enable the target group to reduce self-stigma through structuring of the family routine, having available resources in New Zealand to support their fosters effective problem-solving. Hence, it will provide a sense of empowerment to the population and reduce quality of care.
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