Chronic Condition Self-Management: Working in Partnership toward Appropriate Models for Age and Culturally Diverse Clients
Paterson, Georgina A., Nayda, Robyn J., Paterson, Jenna A., Contemporary Nurse : a Journal for the Australian Nursing Profession
It is estimated that just over 70 per cent of Australians have a chronic condition and this is likely to increase 10 per cent by 2020 (Jordan & Osborne, 2007). Comparing this group to people without a chronic condition they place a greater demand on resources and an already over burdened health care system (Cunningham et al., 2008; Newland & Zwar, 2006). Asthma is one such chronic condition (Newland & Zwar, 2006) and is identified as a national (Saini et al., 2008) and state health priority due to its impact on communities and care resources (Department of Health South Australia, 2007). One in nine children is diagnosed with asthma. Unlike some other chronic conditions, it is not preventable but managed with a focus on symptoms, comorbidity reduction (Couzos & Davis, 2005) and reduced demands on health care intervention (Cunningham et al., 2008; Newland & Zwar, 2006). How can chronic conditions, such as asthma, be better managed before they overwhelm the Australian health care system? Are there solutions and are these achievable within present health systems and care frameworks? This paper will define chronic condition, identify barriers to health care delivery changes for persons with chronic conditions, and explore chronic condition self-management (CCSM) children and adolescents with chronic conditions.
WHAT IS CHRONIC CONDITION?
The literature defines chronic condition in adults as lasting longer than 6 months (Jordan, Briggs, Brand, & Osborne, 2008) and the chance of developing a chronic condition increases with age (Newman, 2008). No such definition exists for children and adolescents with a chronic condition however children with 'special health care needs' are defined as at risk of a chronic condition and as requiring care beyond the general paediatric population (Sawyer, 2007; Sawyer & Aroni, 2005). Thus the concept of chronic condition in children and adolescents differs from that in adults and therefore planned management needs to differ between these groups. Chronic conditions place significant burdens on family units and as these children mature the burden increases for families, health professionals and health care systems (Sawyer & Aroni, 2005). A report by Sawyer (2007, p. 622) found that 'one in five children and adolescents have special health care needs and one in 10 children do not live a full and active life because of the limitations and/or disabilities from their chronic conditions'. If the focus of self-management is not broadened to include children and adolescents, current funding for this strategy will quickly be redirected toward other projects.
BARRIERS TO CHANGE IN HEALTH CARE DELIVERY
The final report of the South Australian Generational Health Review (Government of South Australia, 2003, p. 1) found that for the health industry to be sustainable into the future a shiftin paradigm is required from acute care to primary care focus with its emphasis on early detection and prevention of disease. There are contrasting thoughts regarding the impact of this shiftfor people with chronic conditions. Matheson et al. (2006) studied the management of airway disease in a large cohort of Australians and identified it vital that persons with chronic conditions be managed in acute care areas where specialist professionals are better equipped with expert knowledge. Other researchers believe that better health outcomes are achieved in the primary health care setting (Jordan et al., 2008; Newman, 2008; Wilson et al., 2007) where expert knowledge is also available but perhaps under-recognized and under-utilized.
Asthma is not preventable but early intervention improves clinical outcomes (Kumar & Clark, 2005). Therefore the expertise of a respiratory specialist may be required initially for clinical diagnosis with continued management having a community multidisciplinary and 'partnership in care' approach (Bateman et al., 2008). The majority of people with chronic conditions are seen in primary health settings, predominately by general medical practitioners (GP; Harris, Williams, Dennis, Zwar, & Davies, 2008). …