Understanding Diabetes as a Chronic Disease
Question:
Discuss about the Optimising Care in Chronic Condition for Optimal Care Delivery.
Diabetes is a chronic disease condition resulting in uncontrolled blood sugar and serious damage to other body system with time. The burden of the disease is understood from the fact that diabetes has been the direct cause of 1.6 million deaths worldwide in 2015 (World Health Organization. 2017). In Australia, about 1.2 million people have been diagnosed with diabetes and the rate increased from 4.4% to 5.1% in 2014-2015 (Health.gov.au. 2016). The Australian government implemented many policies to provide optimal care for people with diabetes and meet complex health care needs of affected people. Some example of diabetes related policies include the Diabetes Australia National Policy Priorities 2010 and the Australian National Diabetes Strategy 2016-2020.
The Australian National Diabetes Strategy 2016-2020 is an example of national response to diabetes across all levels of government and it was endorses by the Australian Health Minister’s Advisory Council (AHMAC) on 2nd October 2015 (Health.gov.au. 2018). The main vision of the National Diabetes Strategy is to strengthen all sectors in implementing coordinated approach to reduce social, human and economic impact of diabetes in Australia. It aimed to reduce the social and economic burden of diabetes by preventing and managing diabetes, improving diabetes service and use of primary care service, recognition of patient needs and coordination of health care resource at all levels. The guiding principles for this goal included collaboration and cooperation, coordination and integration, facilitation of person-centered care, measurement of health behavior and minimization of health inequalities. To reduce the quality of life of people living with diabetes, the Australian government planned developing agreed clinical guideline, local care pathways and preventive programmes to support people with diabetes. The national strategy also focused on improving access to self-management education programme and peer support programme (Department of Health 2018). Evidence suggest that diabetes self-management education significantly improves the glycated hemoglobin (A1C) level in diabetes patient (Chrvala, Sherr and Lipman 2016). In addition, the focus on implementing integrated care service is effective as Doherty et al. (2016) showed that integrated medical, psychological and social care in diabetes can reduce psychological and social co-morbidities of diabetes and improve patient’s satisfaction level.
Another evidence of policy aiming to fulfill complex health care needs of people with diabetes includes the National Policy priorities 2010 that focused on better management and prevention of diabetes for all Australians. It priorities care of people with diabetes by several strategies like better accessibility to insulin pump, management of diabetes in aged care services, health literacy for people with diabetes and controlling junk food and sugar beverage advertising and marketing. It was a comprehensive policy that addressed all types of risk factors and issues that increases challenges for people with diabetes (Diabetes Australia 2012). Hence, diverse range of intervention targeting lifestyle, physical activity, diet and other areas are effective in supporting people with diabetes and prevent diabetes. The above review of policy steps and evidence for providing optimal care are all patient centered care strategy, that hold promotes in reaching desired glycemic targets and improving patient’s quality of life (W Powell et al. 2015).
Australian Government Policies for Diabetes Care
The main purpose of this section is to provide recommendation for care of patient and family with diabetes in one particular health district within Sydney. The recommendations for care is based on analysis of case scenario of Joel, a 13 years old teenager, who has been diagnosed with type 1 diabetes recently and informed by the executive summary presented in part A. Joel lives with his mother Kate and 16-year old sister in Western Sydney Local Health District. After the diagnosis of Type 1 diabetes, Joel’s mother is focused on supporting Joel’s health holistically. This can be done by the implementation of patient-centered care plan for Joel. Patient centered care plan is the main determinant of high quality care and it improves the likelihood of equal access to services and achieving good patient outcome. It is necessary for supporting people with chronic illness to enhance satisfaction care, empower patient and holistically address health needs of patient (Berghout et al. 2015). Constant monitoring and care of patient and providing access to appropriate resource to influence health behavior are essential to provide holistic care to patient. Patient-centered care is favored by all patient group (de Boer, Delnoij and Rademakers 2013). To recommend appropriate local health services to provide optimal care to Joel, it will be necessary to identify social, health and psychological issues for Joel and suggest services to patient accordingly.
The main health issue for Joel is the diagnosis of Type 1 diabetes and lack of knowledge about managing the condition effectively. He dislikes taking medications and wants to cease treatment so that he can live like a normal teen. Based on this information, Joel is in need of support from local health care services for controlling his blood sugar level. Western Sydney is a diabetes hotspot and after the establishment of Western Sydney Diabetes (WSD) initiative, various private and non-government sector have come up to work with people with diabetes. As Joel is a newly diagnosed diabetes patient, providing him the right treatment is important. Hence to control blood sugar level of Joel, it is recommended that he and his mother Kate should be referred to general practice services or out-patient clinic to get relevant medication to manage his condition. Joel can be referred to Westmead hospital diabetes clinic which can provide specialist medical care to people with diabetes. The usefulness of this clinic is that it focuses on optimizing diabetes care and treating all form of complication associated with the disease. Hence, clinicians in the clinic can provide the right treatment to Joel and they can also refer them to other allied health services as they work closely with diabetes educators, dieticians and podiatrist (Diabetes Clinics – WSLHD 2018). The advantage of diabetes outpatient clinic in Western Sydney is that it has been developed in a manner to become rapid access and stabilization clinic that fulfills the principle of integrated care for disease management (Western Sydney Diabetes 2018). This recommendation is in relevance with the National Health Strategy Goal of 2016-2020 of improving the quality of life of people with diabetes as the national policy proposed that increasing access to specialist support through local regional networks of care is essential for management of diabetes (Department of Health 2018). Hence, by referreing Joel and Kate to outpatient clinic, it will create the pathway for identifying specialist care and other support services for patient.
Effective Resources for Diabetes Management
In addition, it has been evident from the case scenario of Joel that both Joel and his mother Kate finds the type 1 diabetes as a burden and they lack the understanding that they can engage in physical activity and other normal life activity like other normal children. Kate also want to change dietary choice of Joel to provide holistic care. Hence, from this information, it is recommended that Joel and his mother be referred to diabetes education service and community health services in Western Sydney so they get adequate health education to effective manage type 1 diabetes and live a high quality life. By participating in diabetes education program, Joal can be encouraged to increase level of physical activity and eat healthy food which is in relevance with the optimal care approach provided by National Diabetes Health Strategy 2016-2020. Diabetes education services at Western service have experienced diabetes educator and the general practitioner refer patients to diabetes educators. They provide education to patient as per the patient’s needs by considering health literacy level of patient, stage of disease and type of diabetes. Partnering with diabetes educator is essential for providing optimal care to patients like Joel because they promote behavioral change in patient and empower patients to manage the disease successfully. Diabetes educator act as the main facilitator of behavioral change in newly diagnosed patient and their knowledge helps in providing individualized care plan to patient (Burke, Sherr and Lipman 2014).
Secondly, it is recommended that Joel and Kate visit diabetes clinic in Western Sydney where team of nurse educators, podiatrist, dietician and psychological work with each other to help patient achieve best clinical outcome. This would enhance the likelihood of receiving multidisciplinary diabetes team care. Type 1 diabetes is a condition that requires life-long intensive treatment and self-management approach to lead a good quality life. However, the issue for young patient with Type 1 diabetes is that due to complexity of treatment, they fail to achieve glycemic control and constantly suffer from poor health outcome. To prevent concomitant poor health outcomes for Joel, it is necessary that he engages in multi-disciplinary clinician consultation to gain knowledge about ways to self-manage the condition. This would also enhance skill of Joel and his family related to day-to-day self-management of Type 1 diabetes (Wiley et al. 2015). Hence, apart from receiving ancillary care from general practitioner, Joel must also collaborate with clinicians as outpatient clinic so that other multi-professional team such as specialist physicians, diabetes educator, dietician and psychologist can also work him. The advantage of diabetes specialist service and integrated in Western Sydney is that they intervene promptly to reduce the need for hospitalization and provide patient with the right health resource in the right setting (Western Sydney Diabetes 2018). Integrated service fulfills the elements of patient-centred care by ensuring that young patient like Joel do not feel that mode of delivery disrupts their lifestyle preferences. They use appropriate health apps and technology to integrate care. This is also relevant with the guiding principles of the Australian National Diabetes Strategy 2016-2020 as it mentioned that integration of diabetes care needs to be done by coordination across services, setting and technology (Department of Health 2018). It gave the directive of meaningful use of mHealth apps among consumers and as Joel is a teenager, developing a patient centered mHealth app is necessary so that Joel can effective transition to self-management of diabetes instead of relying on her mother Kate for self-management (Holtz et al. 2017).
A Case Study: Joel’s Diabetes Diagnosis
The above three recommendations related to outpatient visits, specialist care, multidisciplinary and diabetes education services can fulfill the needs for controlling gylcemic control, managing specific disease related complication, diet and physical activity changes and self-management education for Joel. However, another complex issue for Joel was that he was psychologically disturbed after being diagnosed with Type 1 diabetes. He was anxious regarding what would happen if other students comes to know about his condition. He had the belief that he will be discriminated and he would not be able to take part in activities like camps and sports. Hence, considering this issue, it is evident that diagnosis of diabetes also results in poor psychological outcome in patient. They are often depressed and anxious regarding their future life. Therefore, in view of this problem, it is recommended that Joel and Kate are referred to psychological support services in Western Sydney. This care recommendation is also in relevance with Australian National Diabetes Strategy 2016-2020 as it gave the directive that to assist young people to engage in self-management of diabetes, psychological support services are necessary for them (Department of Health 2018).
Outpatient clinic at Westmead hospital can also provide the service of psychologist to Joel and Kate so that they could learn to cope up with Type 1 diabetes (Western Sydney Diabetes 2018). Psychological support program can reduce symptom of psychological distress, improve mood and improve the quality of life of patient with Type 1 diabetes. A research done to evaluate the efficacy of psychological support program on outcome of Type 1 diabetes patient revealed that psychological support is necessary to improve patient’s skill to improve living with diabetes (Forlani et al. 2010). Such psychological support programs covers different aspect of living with the condition and clarifies several misconception related to the disease too. Hence, by the use of integrated care and work with multi-professional team, social, health and psychological needs of Joel in optimally managing Type 1 Diabetes can be fulfilled.
References:
Berghout, M., van Exel, J., Leensvaart, L. and Cramm, J.M., 2015. Healthcare professionals’ views on patient-centered care in hospitals. BMC health services research, 15(1), p.385.
Burke, S.D., Sherr, D. and Lipman, R.D., 2014. Partnering with diabetes educators to improve patient outcomes. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, p.45.
Chrvala, C.A., Sherr, D. and Lipman, R.D., 2016. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient education and counseling, 99(6), pp.926-943.
de Boer, D., Delnoij, D. and Rademakers, J., 2013. The importance of patient-centered care for various patient groups. Patient education and counseling, 90(3), pp.405-410.
Department of Health 2018. Australian National Diabetes Strategy 2016–2020. . Retrieved 23 April 2018, from https://www.health.gov.au/internet/main/publishing.nsf/content/3AF935DA210DA043CA257EFB000D0C03/$File/Australian%20National%20Diabetes%20Strategy%202016-2020.pdf
Diabetes Australia 2012. NATIONAL POLICY PRIORITIES 2010. Static.diabetesaustralia.com.au. Retrieved 23 April 2018, from https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/283db11a-ec5c-479a-adc3-59dd66935d5d.pdf
Diabetes Clinics – WSLHD. 2018. Wslhd.health.nsw.gov.au. Retrieved 23 April 2018, from https://www.wslhd.health.nsw.gov.au/Department-of-Diabetes-and-Endocrinology–Westmead-Hospital-/Outpatient-Services/Diabetes-Clinics
Doherty, A.M., Gayle, C., Morgan-Jones, R., Archer, N., Laura-Lee, Ismail, K. and Werner, A., 2016. Improving quality of diabetes care by integrating psychological and social care for poorly controlled diabetes: 3 Dimensions of Care for Diabetes. The International Journal of Psychiatry in Medicine, 51(1), pp.3-15.
Forlani, G., Nuccitelli, C., Caselli, C., Moscatiello, S., Mazzotti, A., Centis, E. and Marchesini, G., 2013. A psychological support program for individuals with Type 1 diabetes. Acta diabetologica, 50(2), pp.209-216.
Health.gov.au. 2016. Department of Health | Diabetes. Retrieved 23 April 2018, from https://www.health.gov.au/internet/main/publishing.nsf/content/chronic-diabetes
Health.gov.au. 2018. Department of Health | Australian National Diabetes Strategy 2016-2020. Retrieved 23 April 2018, from https://www.health.gov.au/internet/main/publishing.nsf/content/nds-2016-2020
Holtz, B.E., Murray, K.M., Hershey, D.D., Dunneback, J.K., Cotten, S.R., Holmstrom, A.J., Vyas, A., Kaiser, M.K. and Wood, M.A., 2017. Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents. JMIR mHealth and uHealth, 5(4).
W Powell, P., D Corathers, S., Raymond, J. and Streisand, R., 2015. New approaches to providing individualized diabetes care in the 21st century. Current diabetes reviews, 11(4), pp.222-230.
Western Sydney Diabetes 2018. Westernsydneydiabetes.com.au. Retrieved 23 April 2018, from https://www.westernsydneydiabetes.com.au/framework-for-change/specialised-consultation/out-patient-clinics
Wiley, J., Westbrook, M., Long, J., Greenfield, J.R., Day, R.O. and Braithwaite, J., 2015. Multidisciplinary diabetes team care: the experiences of young adults with type 1 diabetes. Health Expectations, 18(5), pp.1783-1796.
World Health Organization. 2017. Diabetes. Retrieved 23 April 2018, from https://www.who.int/mediacentre/factsheets/fs312/en/
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