Perspectives of Managing Chronic and Complex Diseases: Diabetes Mellitus - Essay Example

Perspectives of Managing Chronic and Complex Diseases: Diabetes Mellitus Introduction Chronic diseases have increased in morbidity and mortality rates in the past few decades. With the increase of processed foods, energy-saving devices, as well as new and emerging diseases, the number and occurrence of chronic diseases have increased. Diseases like diabetes, cancer, hypertension, and other cardiovascular diseases are just some of the diseases which have posed significant threats on the life and the quality of life of people. Diabetes mellitus is now considered one of the major chronic diseases affecting the global population. Various efforts to manage this disease have been forwarded with some improvements seen in terms of management. However, there is a need to carry out more effective solutions for this chronic disease. This paper shall discuss the management of diabetes as a chronic disease, applying Wagner’s Chronic Care Model in order to provide efficient outcomes for this disease. This paper acknowledges the importance of self-management and responsibility for one’s own disease; however, other patients are often not eager in taking such responsibility (Eley, 2008). Various models of chronic condition management differ in various ways. It is important to determine if there is one model which can meet all the needs of the clients. The Wagner’s Chronic Care Model shall be evaluated in this regard, alongside coordinated multi-disciplinary care in a primary health care framework (Nolte, Knai & McKee, 2008). Body Ed Wagner’s Chronic Care Model is considered a framework for producing healthy communities (Pittsburgh Regional Health Initiative, n.d). It is multidimensional and in relation to evidence-based guidelines, provides as synthesis of system changes which can provide quality improvement. It is a flexible model which is likely to change based on new evidence. There are six major functions and elements of this model. The first component is the community which includes public and private resources as well as policies. The second component is the health system which refers to how health care is planned, managed and how its payment structure is planned (Pittsburgh Regional Health Initiative, n.d). The third component is the self-management support. This would include education, tools, motivation, as well as patient empowerment. Yet another component is the delivery system design which refers to the structure of the provider organization as well as the organization of patient encounters. The decision support component refers to how clinicians can access and comply with the evidence-based standards for care (Pittsburgh Regional Health Initiative, n.d). Finally, the clinical information system component includes computerized data, electronic medical records, and decision support tools. There are different parts of the world and the country which have applied parts of this model. However, no specific success has been observed in terms of all components put together. There are no specific ways which have been indicated on how each component of the model would be implemented. Improvements in these areas are therefore essential. The community has a significant role in the management of diabetes. Both private and public institutions have roles in the management of diabetes (Stellefston, 2013). The private institutions include the food industry, hospital and private-care institutions, as well as the current work and educational systems which all contribute to the diabetes problem, and can actually help reduce its occurrence and impact. Public institutions include the government and its policies, as well as the different health and social services it is providing for the people (Stellefston, 2013). Where legal policies are in place, it is possible to establish standards in the food industry in order to reduce the impact of unhealthy diet to the consumers. Regulating the food industry can help reduce the impact of unhealthy foods and prevent the occurrence of chronic diseases, including diabetes (Sugarman and Sandman, 2007). The health system component would refer to the planning and management of care for diabetes. The planning for diabetes care would involve the patient and the attendant health care team (Naik, et.al., 2011). This team must be able to indicate their plans for the patient’s chronic care management, working with the patient in order to secure self-management processes as well as evidence-based interventions. Specific elements of self-management would be described below. In relation to decision support, it is important to acknowledge that effective chronic disease programs guarantee that providers are able to access available based on evidence-based standards (Institute of Medicine, 2001). While providers have to focus on expertise, some may be not be willing to do so. Some physicians may not also be using care which refers to evidence-based guidelines (Siminerio, Zgibor, & Solano, 2004). The Community Medicine Inc. in the US has been considered an entity which manages various PCPs and their practice. In smoothing out the details relation to improved diabetes care practice via decision support, facilitation by the Community Medicine, Inc. helped the American Diabetes Association implement their standards of care. As such, the primary health attendants were able to provide presentations for the different practices, highlighting rationale, strategy in treatment of diabetes, and opportunities for referral to the available local diabetes care programs (Siminerio, et.al., 2004). Such efforts provide a major challenge especially as community networks have to extend into a wide radius. Physician education has to be secured in different venues, including telecommunication, regional meetings, as well as lectures in academic settings. The overall goal under these settings included the reduction of hemoglobin HbA1c results, implementing interventions for patients with HbA1c results higher than 9%, managing LDL levels, improving physician and nurse interventions, as well as improving and monitoring blood pressure levels (Siminerio, et.al., 2004). In terms of information systems, timely and useful information about the patients affected is important in chronic care management. It is important under these conditions to develop a registry which can serve practitioners in gaining data on performance as well as results of treatment and related patient data. Physicians and nurses involved in diabetic care are now receiving and using reports from generated database in order to assist in their care of diabetic patients (Haas, et.al., 2013). Laboratory data is also encoded into an access database in order to allow health practitioners easy accessibility into patient information, helping them make quick and timely decisions about chronic care management. These results would include HbA1c levels, LDL, cholesterol, as well as urine microalbumin results. Specific patient results can also be provided based on patient charts entered in each patient visit. Moreover, the head nurses and chief doctors are also inclined to distribute through practice, the rankings of A1c results in order to give the patients and providers data on the performance of practitioners and patients as a whole (Haas, et.al., 2013). Laboratory results including specific patient qualities, doctor visits, as well as charges can actually be secured within the database in order to provide data relating to health insurance, medications, comorbid conditions, as well as possible procedures which may actually be or have already been carried out on the patient. Validation processes are essential in order to refine the database and to facilitate the retrieval of data (Shah, et.al., 2011). Inevitable within this system include plans for monitoring and the development of new approaches to inform patients as well as health providers, including nurses on risk factors which may have to be addressed in the interim or the immediate period. Self-management is most likely the most important component of chronic care management. For diabetic patients, self-management is a significant aspect of patient care because in some cases, it can even mean the difference between the patient’s survival and death. The systems which support the development of informed and active patients often relate to positive patient outcomes (Rosal, et.al., 2011). Self-management is not a traditional approach to diabetes management, however, it seems to be the most effective option for patients. Self-management includes active patient participation and planning, supported by evidence-based practice and patient-centered care. An important element of diabetes care is self-monitoring. This involves teaching the patient what he needs to know about his disease, how to check his blood glucose levels, including the symptoms he needs to monitor in relation to the complications of his health (Rosal, et.al., 2011). The self-administration of insulin and other diabetic medications is also important in diabetes self-management. Where the patient is able to self-administer insulin, and comply with other medication requirements, the management of blood glucose levels can be carried out efficiently. Part of self-management of diabetes includes diet and exercise (Glasgow, et.al., 2012). The symptoms and outcomes of diabetes often relates to obesity. Where the patient is able to understand the importance of diet and exercise, the management of blood glucose levels, including blood pressure, and cholesterol levels can be better secured. With self-management, the patient would feel better empowered and feel in better control over his life and his disease. Through patient participation, better compliance with medications as well as other medical precautions can also be secured (Glasgow, et.al., 2012). The role of the nurse is to assist the patient in the self-management process. This can include phone or text reminders sent to the patient when medications or follow-up consultations would be due. Providing support to the patient in terms of diet and exercise as well as self-monitoring would also be part of the roles of nurses in the self-management process. Effective diabetes chronic disease management also calls for attention given to delivery system design. Team-based care has been known to develop improved outcomes, but within the primary care setting, it is not readily available (Wagner, 2000). While health providers present unique opportunities to secure delivery within the point of care, some programs have generally been secured for hospitals within the point of service. This is based on the acute care model where health services are provided in the hospitals and referrals to specific specialized hospital care are expected. In chronic care management which best provides for the needs of the patients with diabetes, while also considering new ways in care delivery. Countries have established diabetes care programs within primary care settings (Wagner, 2000). Diabetes educators have also been recruited in order to educate and train diabetes care centers within the primary care setting. These educators have been called in to instruct patients on their disease and nurses on their specific functions relating to diabetes care, with the end goal of maximizing the efficiency of diabetes chronic care management. As standards for diabetes care are met, data can then be included in the system-wide diabetes recognition and chronic management process. The Wagner Chronic Care Model also addresses the risk factors of diabetes which includes obesity, smoking, genetics, and other lifestyle factors. The Chronic Care Model addresses these risk factors especially in its components mostly in terms of how the community, including public and private institutions, reacts to such risk factors (Wagner, 2000). Self-management is however the component which impacts heavily on how risk factors are addressed. Self-management can help reduce these risk factors, helping to manage them through lifestyle changes and a more empowered approach to one’s health. The nurse’s role in relation to these risk factors relate to the delivery of health services through health education and by taking an active part in patient monitoring as well as updating patient health status within the information database (Ishani, et.al., 2011). The diabetes chronic care management system has gone through major developments in securing improvements in care practices as well as patient outcomes. By using and coordinating major tools within the system, there have been major improvements in the management of diabetes patients receiving care within primary care institutions (Ishani, et.al., 2011). While it would likely take years for major changes in the micro and macro-vascular elements of the disease to be seen, current developments have so far been favorable. A major factor in ensuring success for chronic care management of diabetes has related to how to have physicians and nurses involved in quality improvement elements and ensuring their responsibility in gathering and reacting to the data gathered (Radhakrishnan, 2012). In asking physicians and nurses to monitor interventions for patients, these health practitioners are not only evaluating the results but are also reacting to them during the encounter (Jansink, et.al., 2010). The information systems, including laboratory results and monitoring of patient outcomes have been eventful in helping collect provider-specific data which has also helped in promoting team spirit as well as motivated nurse behavior. The health providers, including nurses have had difficulties in terms of their resources in meeting patient educational needs (Steinsbekk, et.al., 2012). However, due to networking practices within the health system, diabetic chronic care programs have been successful in ensuring quality as well as sustainable care with options for reimbursement (Jansink, et.al., 2010). The Wagner Chronic Care Model can be used for diabetes education, helping to cover the needs of patients within the community and primary care setting. Within the current fiscal environment where administrators are often wary of services which do not generate revenue, ensuring reimbursement and justifying educator positions has been able to provide sufficient groundwork for additional educator services within the school, community, and office setting (Heisler, et.al., 2010). The limitations of this analysis are recognized, especially as this study is not undertaken within actual clinical settings. However, it presents important points on diabetes chronic care management which can be used in future analysis and future improvements of diabetes care. Refining diabetes care is important especially as chronic care management would likely benefit from it (Funnell, et.al., 2012). Within an integrated system, doctors and nurses within the primary care setting can access the various resources which can secure private practicing which they may sometimes lack (Blakeman, et.al., 2011). Centralized organizations and coordinating structures which provide resources to entire systems, including diabetes education programs, laboratory data, academic medical centers, and information systems are considered important to the success of the chronic care diabetes initiative (Heisler, et.al., 2010). In Canada, there are several chronic disease management programs for diabetes in place. The Primary Care Initiative is one of the programs which have been implemented in different territories of Canada. In a systematic review carried out on the chronic diabetes management carried out in 2006, authors noted that the management system for diabetes involved improvements for glycosylated hemoglobin A1c levels for patients (Campbell, et.al. 2013). Such programs varied in terms of intensity, with some of these programs calling for a modification in electronic medical records, and others also calling for the hiring and recruitment of specific specialized staff, including nurses specializing in diabetes chronic care management. The implementation of chronic disease management programs is a major challenge especially as additional resources and changes in the practice style are usually needed in order to ensure that all patients would have sufficient access (Campbell, et.al. 2013). Primary care reforms have become more widespread in Canada, although it is being implemented in different ways. In most provinces, primary care reforms are aimed at expanding interdisciplinary care, ensuring extended hours for care delivery and ensuring increased focus on prevention of the disease and education of the patient (Fisher, et.al., 2012). In Alberta for example, primary care reforms have mostly referred to primary care networks which seek to increase access to and coordination of care for patients (Campbell, et.al. 2013). A PCN includes primary care physicians who are working with other health providers, including nurses, dietitians as well as pharmacists in order to ensure care for patients in a specific area. Although each network ensures care for patients with and without chronic diseases, chronic disease management for patients with diabetes has been considered a priority for most primary care initiatives. Additional funding is ensured for these primary care centers in order to support activities which are not financially supported by typical physician-based fee-for-service models but which also address specific objectives including chronic disease management (Campbell et.al., 2013). Such funds may then be used to hire more nurses, to support allied health care professionals working within their full scale of practice or in supporting other initiatives including chronic disease management programs. With differences in local priorities, availability of health staff, as well as historical elements of care, it has been noted that primary care initiatives have been able to support various kinds of chronic disease management programs. In relation to differences in efficacy and costs between various CDM programs, health managers and diabetes care managers have sought to establish what kinds of CDM programs have been used to manage diabetes by Alberta’s primary care networks and whether these choices have been consistent with present evidence. The primary care network is however lacking in some aspects, mostly in terms of improvements in the quality of life of patients as well as the affordability of care. Conclusion Diabetes chronic care management is an essential part of the healthcare practice. However, it requires various elements in order to ensure its success. The Wagner Chronic Care Management system provides various components relating to the design system, community, the health system, decision support, as well as self-management in order to ensure and promote improved patient outcomes. In applying this chronic care management system for nurses involved in the care of diabetes patients, the system presents benefits in the identification of risk factors as well as the application of self-management activities which can serve patient needs, preferences alongside evidence-based care. The primary care networks for Canada serve as foundations for chronic care management and Wagner’s model complements the current chronic care management of Canada. 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