Analysis of NSW Chronic Care Program Policy in Australia - Literature review Example

Introduction A health policy is basically a plan that steers the action and direction of investment designed with an aim of improving healthcare, alleviating suffering or preventing illness. It can be presented as practice guidelines, bureaucratic edits, laws or guiding principles (Buse, Mays, & Walt, 2005). The makers of a health policy have a great task of navigate between demands and competing interests in order to develop a pragmatic response to health problems (Smith-Merry, Gillespie, & Leeder, 2007). According to Redman, Jorm, & Haines (2008), evidence-based policy making is very influential and has a great potential to an effective health policy. Analysing a health policy increases the impact of a policy as well as providing information that may be crucial in allocation of resources that are already scarce. A successful health policy in regard to the achievement of its preferred goals is an indication of more support or an increase in funding. Thus, an analysis of a health policy is a boost to any chances of successful implementation of future policy based on revealing of opportunities (Cheung, Masoud, & Leeder, 2010). This report involves an analysis of NSW Chronic Care Program Policy in Australia. Policy issue With advances in healthcare and technology, life expectancy has increased and people are surviving diseases that had previously been referred as fatal. However, the changing lifestyles and such advances have led to higher incidences of chronic disease. Chronic diseases consumes more than a half of the healthcare budgets in most countries (WHO, 2005). Thus, management of chronic disease is a great priority for any country that is aimed at reducing the burden of the systems of health care and increasing the quality of life. According to Singh (2005), much is known about what is essential in reducing this burden but there is still more to be known about the required policies to ensure consistent setting up and maintaining of the interventions. Each country has its own requirements and there is no single policy that is appropriate or relevant to all contexts and systems. According to WHO (2008), chronic diseases are characterised by a generally slow progression and long duration. Centres for Disease Control and Prevention (CDC, 2008) define chronic disease as a condition that once acquired is not cured. Australian Institute of Health and Welfare (AIHW, 2013) define chronic diseases as the ones mostly characterised by multiple risk factors, prolonged course of illness, complex causality, long latency periods, disability or functional impairment. In addition, most of them are not cured completely and do not resolve spontaneously. Many illnesses are considered chronic and the Australian most common chronic conditions are stroke, Ischaemic heart disease, depression, lung cancer, diabetes (Type 2), colorectal cancer, arthritis, asthma, osteoporosis, chronic kidney disease, chronic obstructive pulmonary disease (COPD), and oral disease (AIHW, 2013). Rabin et al (2007) add that clinical, laboratory and population-based studies show various risk factors that are related with most chronic diseases which include tobacco use, lack of physical activity, high energy intake, and unhealthy diet. In addition, age, alcohol intake, environmental pollutants and hereditary factors also play a significant role. Based on this information, it is clear that chronic disease is one of the most important challenges that face health systems not just in Australia but throughout the world. There is a need to design effective chronic care policies and programs. Chronic care program policy in NSW Australia was embarked in 2000 in order to improve the quality of life of those with complex and chronic conditions, their families and carers and also prevent unavoidable and unplanned hospital admissions (NSW Government, 2013). More attention is required on chronic illness because it constitutes 70% of the total burden of injury and illness that Australian population experiences where the proportion is expected to increase to 80% by 2020 (AIWH, 2004). The ageing population as well as an increasing prevalence of risk factors in regard to chronic conditions have increased morbidity and mortality from chronic diseases (Dunstan et al, 2002). As Tobias et al (2008) state, the increasing trends had resulted to more pressure on the systems of health. Harvey (2003) noted that in NSW alone more than $ 1.1 billion were spent on patients with chronic diseases in a span of one year. In addition, chronic care was identified as a major component that results to rising costs in healthcare in Australia with a likelihood of consumption of about 75% of the health budget in future. Chronic Care Program Policy (NCCP) Established in 2000 NCCP is a policy that broadly addresses the chronic illness care in NSW Australia with an aim of improving the quality of life for those with chronic illness and reducing inappropriate admissions to intensive acute care hospitals (NSW Health, 2007). The effectiveness of this policy can be assessed based a framework of goals, resources, obligations and opportunity (Rütten et al, 2003). The NSW Chronic Disease Strategy outlines the key developments in the practice and literature of chronic care. The goals of the policy are concrete and explicit and include reduction of crisis situations as well as unavoidable and unplanned admissions based on both quantitative and qualitative measures (NSW Department of Health, 2006). Financial resources were allocated with $ 15 refunding annually. Human resources and organisational capacity which include provision of a robust services and infrastructure underpinning the program were addressed (Commonwealth Department of Health and Ageing, 2006). However, the challenge is whether the resources were sufficient. In regard to monitoring and evaluation, the policy showed the mechanism for evaluation and monitoring of the strategy and development of monitoring systems based on an agreed and standardised methodology. The policy also acknowledges the importance of stakeholder involvement which includes the community, doctors, nongovernmental organisation and hospitals. The initiatives employed in this policy can be mainly be classified in two levels; delivery-level and system-wide initiatives. Based on delivery initiative, the policy focuses on managing chronic diseases based on healthcare organisation, community resources and policies, clinical information systems and self0management support. The policy resulted to better processes of the adoption of the system in the organisation. It resulted to improvement of the quality of care in regard to people with long-term conditions. This initiative also results to reduced costs as well as reduced risks of hospital admissions. Such achievements have been proven in regard to associated reduced diabetes, congestive heart failure and asthma as well as reduced use of healthcare services or costs of health care (Sperl-Hillen et al, 2004). Based on system-wide initiative, the strategy is based on community and policy aspects in regard to improvement of chronic care. It puts more emphasis on intervention in health services and community activities. Thus it addressed what determines chronic diseases as well as economic, social and cultural factors that may affect quality and quantity. As Schwartz and Brownell (2007) state, such initiative adopted in this policy ensures consideration of health inequality and its causes. In general, the above initiatives employed in implementation of NCCP policy led to the following achievements (NSW Government, 2013): Engaging more clinicians and managers from both acute and community health services in improvement of care and outcomes for chronic disease patients Decreased hospital admissions by saving more than 25,000 inpatient bed days for patients with chronic heart failure and COPD. Significantly improved diagnosis as well as management of chronic diseases. Improved understanding of managers and clinicians in chronic care management as well as increased ability in improvement of patients with chronic disease. Enhanced teamwork and communication across health services Developed resources that help in improving care in health services for patients with chronic diseases Although there were such achievements, this policy is not effective especially in addressing issues at individual level. Thus, it is suggested that the policy puts more emphasis on individual-level initiatives to increase effectiveness. Such strategy will be focused on coordination of care for the families or users of health services. This will include various approaches such as psychological or behavioural-based theory, stages of change models or forms of case management. For instance, stages of change model will target on reducing or elimination of risk factors such as cessation of smoking, and alcohol and drug addiction (Evers et al, 2006). Such approach to the policy calls for intervention at different points in change process with suggestion of the need for prevention, treatment, and palliative care at various stages of the disease. This will also assist in changing behaviours of the patients such as exercising and eating habits. This individualised policy will also be motivating for families and will be more effective if integrated in the entire system approach in the management of chronic disease. In conclusion, the proposed plan will be based on immediate, mid-term and long-term strategies and will focus on the following key elements in addressing chronic illnesses: Provision of strong leadership at organisational, local and national level Ensuring vigorous collection of information and sharing of data Providing a care that is based on the needs of the people or individual needs with the ability to identify people with different levels of need Emphasise on targeting risk factors including initiatives for prevention of widespread of disease Empowering those who have chronic diseases and supporting self-management Involve all levels of stakeholders such as at individual and community level, public services and private employers. References AIHW (2004). Health system expenditure on disease and injury in Australia, 2000–01. Canberra: Australian Institute of Health and Welfare. Australian Institute of Health and Welfare (2013). Chronic diseases, available at: http://www.aihw.gov.au/chronic-diseases/ Buse,. K, Mays, N., & Walt, G. (2005). Making Health Policy. London: Open University Press; 2005. CDC (2008). National Center for Health Statistics definitions: health condition, Atlanta, Unted States Centers for Disease Control and Prevention, available at: http://www.cdc.gov/nchs/datawh/nchsdefs/healthcondition.htm Cheung, K.K, Masoud, M., & Leeder, S. (2010). Health policy analysis: a tool to evaluate in policy documents the alignment between policy statements and intended outcomes. Australian Health Review, 34, 405–413 Commonwealth Department of Health and Ageing (2006). National Health Priority Action Council, National Chronic Disease Strategy. Canberra, Available at http://www.health.gov.au/internet/wcms/publishing.nsf/Content/pq-ncds Dunstan, D.W, Zimmet, P.Z, Welborn, T.A, de Courten. M.P, Cameron, A.J, Sicree, R.A, Dwyer, T., Colagiuri, S., Jolley, D., Knuiman, M., Atkins, R. (2002). The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care, 25, 829–34. Evers KE et al. (2006). A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention. Health Psychology, 25, 521–529. Harvey, P. (2003). Managing health care in Australia: steps on the health care roundabout? Australian Journal of Primary Health, 9, 105–8. New South Wales Health (2001). Improving health care for people with chronic illness – a blueprint for change 2001–2003. Sydney:. Available at http://www.health.nsw.gov.au/pubs/2001/chronic.html New South Wales Health (2007). NSW Chronic Care Program. Sydney, Available at http://www.health.nsw.gov.au/health_pr/chronic_care/ NSW Department of Health (2006). NSW Chronic Care Program Phase Three: 2006–2009. Sydney, Available at http://www.health.nsw.gov. au/pubs/2006/chroniccare_3.html NSW Government (2013). NSW Chronic Care Program, available at: http://www0.health.nsw.gov.au/cdm/nsw_chronic_care_program.asp Rabin, B.A, Boehmer, T.K, Brownson, R.C. (2007). Cross-national comparison of environmental and policy correlates of obesity in Europe. European Journal of Public Health, 17, 53–61. Redman, S., Jorm, L., Haines, M. (2008). Increasing the use of research in health policy: the Sax Institute model, The Sax Institute. Australasian Epidemiologist, 15, 15–8. Rutten, A., Luschen, G., von Lengerke, T., Abel, T., Kannas, L., Rodríguez, Diaz, J.A, Vinck, J., van der Zee J. (2003). Determinants of health policy impact: comparative results of a European policymaker study. Soz Praventivmed, 48(6), 379–91. Schwartz, M.B., Brownell, K.D. (2007). Actions necessary to prevent childhood obesity: creating the climate for change. Journal of Law and Medical Ethics, 35, 78–89. Singh, D. (2005). Transforming chronic care: evidence about improving care for people with long-term conditions. Birmingham, University of Birmingham. Smith-Merry, J., Gillespie, J., & Leeder, S.R. (2007). A pathway to a stronger research culture in health policy. Australia NewZealand Health Policy, 4, 9. Sperl-Hillen, J.M et al. (2004). Do all components of the chronic care model contribute equally to quality improvement? Joint Committee Journal of Quality and Safety, 30, 303–309. Tobias, M., Taylor, R., Yeh, L.C, Huang, K., Mann, S., Sharpe, N. (2008). Did it fall or was it pushed? The contribution of trends in established risk factors to the decline in premature coronary heart disease mortality in New Zealand. Australian New Zealand Journal of Public Health, 32, 117–25. World Health Organization (2005). Preventing chronic disease: a vital investment. WHO global report. Geneva. World Health Organization (2008). Chronic diseases. Geneva, available at: http://www.who.int/topics/chronic_disease/en Read More