Chronic Illness and Diagnosis
A chronic disease is any illness that has a prolonged course and neither resolves spontaneously nor is curable. Chronic illness can bring significant disability and early death and affect every aspect of life-how one eats, works, and loves. Having a long-term illness can demand profound life changes. Managing symptoms, changing diet, taking medications, and interacting with the medical care system are but a few of the tasks entailed. Controlling the inevitable emotional reactions to the disease-anger, fear, and isolation is no easy feat. Life’s tasks are often more difficult because people may feel unwell and their ability even to do basic activities may be affected. Four diseases alone-asthma, depression, diabetes, and congestive heart failure afflict half of all those with chronic illness. Lorig, Holman, Sobel, et al. (2000) Living a Healthy Life With Chronic Conditions. Bull Publ. Co.
Chronic Illness Interventions
One successful multidimensional approach to caring for patients with chronic illness within primary care is “the chronic care model”. This model includes system changes designed to provide both patient and provider with support for disease management. Examples include linking patients with community resources; accessible guidelines to inform provider’s clinical decisions, and clinical information systems that foster integrated care and track actual disease management. Greenfield , Kaplan, Ware, et al. (1988) Journal of General Internal Medicine.
Other Chronic Illnesses
Arthritis, Back Problems, Cancers; Fibromyalgia/Lupus; Heart Dx; Kidney Problems; HIV/AIDS; Pulmonary Dx; Stroke;Vision & Hearing Problems.
Key Care Concepts:
Create provider-patient partnerships. Discuss chronicity of the disease. Remember lifestyle changes and risks. Screen for depression and substance use. Integrate treatments, access community resources. Create systems to deliver preventive care. Create systems to support self-management. Approach ultimate goals with intermediate steps. Always assess for adherence. King & Wheeler (2007). Medical Management of Vulnerable Patients and Underserved Patients. Lange publ.
Social Issues & Barriers To Care
The risks of developing chronic diseases and their complications are highest in people from ethnic minority populations and the poor. These translate into higher mortality and morbidity rates as well.
For people in low-income groups suffering from chronic disease, the old adage rings true: People are poor because they are sick and sick because they are poor. Chronic illness may make it more difficult to remain employed, leading to lower socioeconomic status in turn; lack of insurance and poverty make it more difficult for patients to obtain appropriate care. Not having health insurance is one of the most obvious barriers to care, and can be devastating for someone with a chronic condition. The uninsured tend to have their diseases diagnosed at more advanced stages, receive less preventive care and, once, diagnosed, receive less therapeutic care. Predictably, the uninsured chronically ill are more likely to have poorly controlled illnesses
Often the US health care system produces patients uninformed about their illness and not empowered to care for themselves. Also, health care providers receive little training in caring for the chronically ill, and work in inadequate systems to support the patient and providers. King & Wheeler (2007).
Chronic Illness & Resources
Brain Injury Association of Florida – Sarah McCormick – 352-335-6001; 800-992-3442
Crisis Center Alachua County (Suicide Prevention, referrals for substance abuse, domestic violence) (352) 264-6785
Shands & UF UPREACH Rehabilitation Center 352- 265-5491
Vocational Rehabilitation 352-955-3200
Chronic Illness Facts
King & Wheeler (2007). Medical Managemnet of Vulnerable Patients and Underserved Patients. Lane publ.
Chronic diseases are common in the U.S. with about 100 million people (almost half the population), have at least one chronic illness.
Ninety percent of people over 65 have one chronic illess and about 65% of children are disabled by chronic conditions.
Three fourths of U.S. health care dollars go to caring for those with chronic illness, with chronic diseases causing 70% of all deaths in the United States.