Analysis of Health Issue Strategy in the Community Using a Primary Health Care Framework - Literature review Example

ANALYSIS OF HEALTH ISSUE /STRATEGY IN THE COMMUNITY USING A PRIMARY HEALTH CARE FRAMEWORK Introduction Since the Alma-Ata Declaration in 1978, the framework of primary health care (PHC) has been more seriously embraced by national and supra-national bodies in ensuring health and better quality of life for all peoples (WHO, 2010). Defined by the said Declaration, PHC refers to the essential health care based on practical, scientifically sound and socially acceptable methods and technology that are made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination (ICPHC, 1978). Operationally, it is about reduction of exclusion and social disparities in health, organizing health services around people’s needs and expectations, integration of health into all sectors, pursuit of collaborative models of policy dialogue, and increased stakeholders’ participation (WHO, 2010). This paper is deemed to begin with a brief description of the aforementioned framework as it makes a case for PHC for Alzheimer’s disease (AD) patients and their caregivers. This is occasioned by an eye-opening encounter with an AD patient, during a two-week clinical practice that ran from 26 April to 9 May, 2010, in a community in Sydney, New South Wales (NSW). Due to the tolls of AD, the patient and his family caregiver(s) were enduring burdens that were either unnecessary or possible to alleviate had they knew how to tap the potential help available around them, and had the community been made more ready to extend assistance to them. Problem statement Encountering the AD patient and his wife and caregiver, and hearing them about the difficulties that they go through, one cannot help but think of ways to bring them respite particularly in the context of the current system of health care delivery. To date, health care delivery system has shifted from an acute care focus and hospital-based delivery to illness-prevention and management coupled with community-based delivery of care (McEwen, 2002, pp. 4) – precisely constituting the essence of the integrated framework of PHC. It is very significant, then, to note the case of the AD patient and his family who are obviously burdened by the 24-hour care required by the said medical condition. This is even more complicated by the fact that they cannot count much on the support by the community. It was not helpful either that the community is found to have a below par level of awareness on dementia and AD. The AD patient and his family find themselves isolated, too, as they are apprehensive to speak of their difficulties to other members of the ethnic group in the vicinity for fear that it would cause shame on their family. With this as a background, this paper would delve on such important issues as implementing nursing care for the AD patient and providing support to the patient’s caregivers. Too, it would also touch on educating communities on dementia and AD. Population affected by the problem Having a relatively older population – along with Victoria, Tasmania and South Australia – than other States and Territories, NSW, in 2005, had one (1) in three (3) cases of around seventy one thousand three hundred sixty (71,360) Australians with dementia (Alzheimer’s Australia, 2005). Specifically, the AD client in this paper is Joseph. His primary family caregiver is Mary, his wife. They belong to a middle class Italian family in Sydney. They have two sons, aged 38 and 35, and a daughter, aged 31. The eldest son lives in different State; the middle son and the daughter live within an hour drive from their parents’ home. All of Joseph and Mary’s children are married. They have seven grandchildren. Mary has a widow sister who lives nearby. It is significant to point out here that, to a certain extent, the Italian family appears to limit to themselves the task of caring for their patient. To this observation, the studies by Di Carlo et al. (2002) on the incidence of dementia and AD among Italians, and Ravaglia et al. (2005) on the association between higher risk of AD and poor education among Italian descents resonate. Key stakeholders Dementia stakeholders in NSW are primarily the older people with severe and persistent behavioral and psychological symptoms of dementia in residential, community and flexible aged care services. They also include the AD patients’ caregivers, who may either be family members or professional caregivers. The clinicians – such as the GP’s – who provide care to persons receiving services for their dementia and the volunteers in these services are numbered too among the stakeholders (DBMAS, 2008). Community agencies There are a good number of community support systems available for AD patients and their caregivers in NSW. The NSW organizations of Alzheimer’s Australia’s – a national body for people living with dementia, their families and caregivers -- provides information on the dementia and AD, support to the patients, their families and caregivers, advocacy, and education through its many support services – such as the Dementia Helpline, the Library & Information Services, caregivers education programs and counseling services. The resources that Alzheimer’s Australia offers covers all aspects of dementia care – ranging from practical management strategies to latest information on drugs and research (Alzheimer’s Australia, 2010). NSW also holds the main office of the Southern Division of the General Practice (SDGP, 2008) that published a chronic disease management program on the management and care of patients with dementia. SDGP regularly holds courses for caregivers regularly throughout the state, providing information and opportunities for discussion and support as well as advice on the NSW Action Plan on Dementia 1996-2001. One of SDGP’s purposes is to provide general practitioners with a resource for the care of people with dementia that encourages early intervention, ongoing management throughout the course of the disease and partnership with caregivers and other service providers (Baehrer-Kohler, Krebs-Roubicek & Ephraim-Oluwanuga, 2009, pp. 84). Besides the medical side of dementia and AD, legal and financial concerns resulting from these diseases are served by the Guardianship Tribunal by the NSW government. This government body may be tapped for arrangement of a will, an enduring power of attorney, enduring guardianship and other issues (Guardianship Tribunal, [n.d.]). Nursing and other medical professional roles in PHC An operationalization of PHC is choric self-management education programs that aim to empower patients by providing them information, skills and techniques for the improvement of their capacity for self-care intending ultimately to improve their quality of life (Bahrer-Kohler, Krebs-Roubicek & Ephraim-Oluwanuga, 2009, pp. 81; Kennedy, Gately & Rogers, 2004). Even in this set-up, though, those in nursing profession never run out of roles. In fact, they are still relied on to deliver comprehensive, competent, appropriate and effective client care in any given setting. The most important nursing roles in community based practice are, accordingly, their being managers, health educators, advocates, care providers and counselors. The amount of time that they spend in each role varies from setting to setting, client to client, and day to day (McEwen, 2002, pp. 27; Schmidt, Lingler & Schulz, 2009; Ottawa Charter for Health Promotion, 1986). The roles of the other healthcare professionals have changed, too. They are now more of partners, consultants, interpreters of symptoms, and resource persons who can competently offer suggestions for treatment (Baehrer-Kohler, Krebs-Roubicek & Ephraim-Oluwanuga, 2009, pp. 81; Schmidt, Lingler & Schulz, 2009). Even patients have been given new responsibilities. They are now expected to monitor symptoms, report on them, and try to monitor the disease on a day-to-day basis (Baehrer-Kohler, Krebs-Roubicek & Ephraim-Oluwanuga, 2009, pp. 81). Literature review The most common form of age-related dementia (Laine & Goldmann, 2009, pp. 232-256; Bertram, 2007, pp. 1; Berr, Wancata & Ritchie, 2005), AD is characterized by progressive and insidious neurodegeneration of the central nervous system that eventually leads to a gradual decline of cognitive function or progressive irreversible intellectual loss (Rubin, 2006; Ebersole, 2005, pp. 415-416). People with AD get forgetful and can later have problems doing everything things such as eating, taking a bath, getting dressed (Laine & Goldmann, 2009, pp. 255), lighting a gas, finding one’s way, attending to personal hygiene, even finishing a sentence (Dementia Factsheet, 2004). The prevalence is ten per cent (10%) for individuals who are sixty-five (65) years and older, encompassing ninety per cent (90%) of all AD. The incidence increases from less than one per cent ( Read More