HIV and the Use of Self-Managed Care - Coursework Example

HIV HIV and the Use of Self-Managed Care HIV 2 HIV and the Use of Self-Managed Care The concept that changing a patient’s behavior will affect the efficiency and success of controlling disease is an idea that is leading to embraced policies on self-management support programs. Utilizing programs that teach patients better behaviors and life skills can prevent a great number of more costly treatments at emergency room and hospitals. The cost effectiveness of this policy coupled with the added benefits to the quality of life for patients of many conditions and illnesses has led to an increase in the number of programs available to the public. An organization called Living Well, which is funded by the National Health Service the public health system in the United Kingdom, has embraced this concept of wellness and successfully lead a great number of those suffering from HIV and AIDS through the problems resulting from the diagnoses. HIV infection care was previously managed with progressive immunosuppressant therapy, increasing ill health and the development of pre-terminal AIDS-defining infections and cancers. With the advances brought about by antiretroviral therapy since the mid 1990’s HIV infection has become a chronic condition, managed and maintained within an ability to have an elevated quality of life from those who suffered before these treatments were available. These advances have presented new challenges to those who are no longer dying of a disease but living with a chronic condition. According to the progress report developed by the United Nations General Assembly Special Session on AIDS in 2008 the United Kingdom has the United Kingdom has “a relatively low prevalence of HIV and AIDS.” (United p. 2) According to the same report as of 2006 there are 73,000 people living with HIV. This figure roughly HIV 3 amounts to “121 persons living with HIV per 100,000”. (United 2008 p. 2) With public healthcare available to the citizens of the United Kingdom obtaining medication and medical treatment has been accomplished with an average wait of 48 hours for a patient to obtain care. The recommended actions in the report are as follows: 3.2 ARVs have been widely available throughout the UK since their introduction in the mid-1990’s and are prescribed in line with guidelines agreed by the British HIV Association (BHIVA). In 2001 in response to concern about increasing rate of sexual ill-health in England, including HIV, the Deparment of Health published the first ever national strategy for sexual health and HIV. HIV is prioritized in four of the five goals which also address increasing rates of other sexually transmitted infections (STIs) and unplanned pregnancy. Action on HIV has included: Publication in 2007 of Tackling Stigma, the Department of Health’s action plan on responding to HIV related stigma, including the funding of three new projects; Sustained and increased (20%) funding for HIV social care over three years from 2008-09; Sustained and increased funding for national HIV health promotion interventions for men who have sex with men (MSM) and African communities, the groups more at risk; Funding to support the development of HIV pediatric networks outside of London (where they already exist) (2006); Publication of standards for HIV Care Services complementing BHIVA’s treatment guidelines (2003); Establishing an independent Advisory Group on Sexual Health and HIV to monitor implementation of the national strategy. Membership includes civil society and people living with HIV (2003). (United, 2008 p.5) This indicates a strong public policy response to the epidemic. The UK has utilized resources available to work towards administering to this disease and create a situation HIV 4 that promotes a quality of life for those with the illness. According to AVERT, an international AIDS charity: In fact, statistics show that the epidemic has expanded, with the annual rate of new HIV diagnoses rising almost threefold between 1995 and 2005, when it peaked2. Estimates for 2006 and 2007 indicate that the number of new HIV infections in the UK is now stabilizing, and may even be declining slightly. (AVERT 2007) As the care for HIV and AIDS infected patients has been addressed in the United Kingdom, the concept of self-care has taken on a preventative aspect of the continuation of life for those working with this epidemic. These figures represent a portion of the population which must deal with a disease that has strong physical and emotional consequences. Society has designated HIV as a disease of social relevance. Those afflicted can be seen as having created the situation for themselves by virtue of sexual contact or drug use. The societal pressures of being diagnosed with HIV can diminish the capacity of the patient to live a quality life. The nature of the community to shun those afflicted, coupled with the depression that can follow can greatly decrease the overall well-being of the patient and lead to a lower ability to fight the consequences of being HIV positive. A need for outside support becomes vital in the continuation of a successful life which must make changes and behavioral adjustments to create an overall sense of well-being. The importance of the “Promotion of Living Well” (OPSI, 2008) was reinforced by the Parliament of the United Kingdom in a policy written that specifically addresses the local authorities rights and responsibilities in a government act that addresses the local authorities on these topics. The act reads that HIV 5 (1) Every local authority are to have power to do anything which they consider is likely to achieve any one or more of the following objects— (a) the promotion or improvement of the economic well-being of their area, (b) the promotion or improvement of the social well-being of their area, and (c) the promotion or improvement of the environmental well-being of their area. The act further individualizes this mandate by stating that: (4) The power under subsection (1) includes power for a local authority to— (a) incur expenditure, (b) give financial assistance to any person, (c) enter into arrangements or agreements with any person, (d) co-operate with, or facilitate or co-ordinate the activities of, any person, (e) exercise on behalf of any person any functions of that person, and (f) provide staff, goods, services or accommodation to any person. (OPSI, 2008) As society embraces the idea that the entire well-being of a country, of a community, and of an individual will determine the success or failure of dealing with the unchangeable circumstances that structure that organism, then the prevention of serious complications can be avoided. This will decrease the cost physically, emotionally, and financially. The organization Living Well emphasizes the need for the total involvement of the patient in their own care. On their website they describe themselves as: Living Well is an NHS-funded organization aimed at helping people improve their quality of life. Living Well offers a wide range of health-related services that are designed to increase confidence, improve decision making abilities, and enhance self-esteem. (Living Well, 2008) It is the concept of this organization that if a patient’s general well-being is provided with services and they are maintained mentally they will serve themselves more completely in HIV 6 the maintenance of their condition. The goals of the organization are listed in their hope for their members. Those that have joined Living Well have reported many benefits, here are just a few of them: Increased confidence and optimism; Greater sense of control; Enhanced self-esteem; More able to make informed decisions; Increased motivation; and Better social life. ( Living Well, 2007) These goals work with the idea that a patient whose life is well managed at a well-rounded level can more efficiently manage the specific needs of their condition. Therefore, this acts as a preventative measure in how the disease may or may not progress. In an attempt to combat the societal pressures brought forward with a diagnoses of HIV, Living Well provides programs that teach a patient to embrace and successfully cope with the condition. One of the services provided is the Positive Self-Management Program. This program covers a variety of connected topics that must be addressed by a patient living with HIV. Living Well’s program utilize a “holistic and inclusive approach.” Therefore, a wide variety of topics are covered in the program. Subjects covered in the PSMP include: Techniques to deal with problems such as frustration, fear, fatigue, pain and isolation. Appropriate exercise for maintaining and improving strength, flexibility, and endurance. Communicating effectively with family, friends, and health professionals. Nutrition. Evaluating symptoms. Advanced directives. How to evaluate new or alternative treatments. HIV 7 How to best integrate medication regimens into daily life so they can be taken consistently. (Living Well, 2007) As the topics of physical, mental, and emotional well-being are addressed, the success with which a patient can manage all of the details of the impact the condition will have on their life is supported. Promotion of general well-being has become increasingly accepted through its value for prolonging life through education on obesity, on physical fitness in relation to aging, and to managing the symptoms of chronic disease. A document prepared by the Agency for Healthcare Research and Quality out of Rockville, Maryland in the United States of America outlines the prospective benefits to programs that support well being. Self-management support programs assume a complex sequence of effects. Developers expect these programs to change patients’ behavior by increasing the patients’ self-efficacy and knowledge. Improved behavior is expected to lead to better disease control which should, in turn, lead to better patient outcomes and reduced utilization of health care services, particularly preventable emergency room visits and hospitalizations, and ultimately to reduced costs. (AHRQ, 2007) This statement supports the need for successful patient self-management and for the institution of programs to facilitate this need. These types of programs, not only help the patient, but promote a more financially stable health care system. Successful management of a disease decreases the expenditures for emergent care and hospitalization which supports the needs of the community. When care that could be prevented is prevented, it opens up resources for others who are in need of medical attention. When personal responsibility for healthcare is ignored, then the preventable medical outcomes help to clog a overburdened system. Wellness care has societal benefit as well as HIV 8 personal benefit. The responsibilities of the patient must be emphasized in order to successfully manage any chronic illness. When programs teach patients about successful daily maintenance of well-being, the responsibility of the patient to execute those responsibilities gives the patient some control over the way they can feel as they manage the illness. The education is crucial in the development of a quality of livable and enjoyable life. In the report by the Agency for Healthcare Research and Quality, they state that: Programs that provide this support - so called “self management support” - have been developed in recognition that treating chronic illness requires a new model of care. In 2003, the Institute of Medicine defined self-management support as “the systematic provision of education and supportive interventions by health care staff to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem solving support. (AHRQ, 2007) The inclusion of well-being into policy as a motivator to encourage change in behavior brings with it a challenge in developing innovations that will provide evidence base outcomes. While the rational behind evidence based theory in public health initiatives is understandable the background that evidence based came out of scientific medicine means that the accuracy and consistency in developing robust research methodologies is not easy to transfer. Under the biomedical domain the expectation of evidence base would expect to deliver conclusive guidelines, however in the public health sector this would be difficult to achieve. The public and individual need for patients to take on the responsibility of their car leads to evidence based policy to motivate service providers to come up with HIV 9 innovative adaptations of programs and projects that will meet the policy aims. Evaluating these programs present problems of evidence based on clearly subjective issues. The outcomes may also bring conflict with existing policies e.g. the decision that informed patients may have with regard their current prescribed regimes may be in conflict with the doctors. Also the subjective aspect of generating well-being is extremely difficult to establish when specializing in particular area. Careful consideration regarding the level of responsibility placed on the patient might individualize the risk if the wrong decisions are made. This could set the patient to fail Who decides when people are ready to make such decisions? The question of ultimate responsibility becomes more relevant. The degree of participation in educating the patient balanced against the use of medical professionals becomes subjective when care fails. The level that is determined to be successful has a wide assortment of factors that are relevant to the final outcome. The result can not be truly quantified because factors that are not within the control of the patients, the programs, or the medical professionals will create unidentifiable problems when trying to assess the experience of the patient with the disease. The concept of self management by increasing patient’s confidence and enhancing self belief and self efficacy to ultimately changing behavior was first developed in the 1960’s and 1970’s. Today, self-management is seen as an integral and central part of care for people with a chronic conditions. The potential outcome linked to government policy is that improved participant behavior will translate into making healthy choices, thereby taking more control over the consequences of those choice and in turn helping patients to HIV 10 make better use of healthcare services. Living Well has created a program that is servicing the needs of HIV patients by giving them the tools to manage a difficult, chronic illness. As the need for an overall sense of positive well-being is accepted as a integral part of the patient care, society is discovering benefits to its health care system, its economic investments in that system, and in the availability of medical resources. While the data on the success of these programs is difficult to assess, the quality of life that is reflected by the patients has verifiable value. Living with HIV can be managed and controlled with the proper medical attention pared with the proper education that will increase the quality and length of life. HIV 11 References Agency for Healthcare Research and Quality (2007). Patient Self-Management Support Programs: An Evaluation. Final Contract Report. AHRQ Publication No. [Online] Available online at http://www.ahrq.gov/qual/ptmgmt AVERT (2007) AIDS & HIV in the UK - The Current Situation [Online] Available at http://www.avert.org/aids-uk.htm Living Well (2007) Who Are We? [Online] Available at http://www.livingwelluk.com OPSI - Office of Public Sector Information (2008) Local Government Act 2000 2000 Chapter 22 - Promotion of economic, social or environmental well-being etc, [Online] Available at http://www.opsi.gov.uk/Acts/acts2000 /ukpga_20000022_en_2 United Nations 2008 United Nations General Assembly Special Session On AIDS (UNGASS) - Progress Report 2008, [Online] Available at http://data.unaids.org /pub/Report/2008/uk_2008_country_progress_report_en.PDF Read More