FFP1 Living with Chronic Conditions Lecture Notes PDF

Living with Chronic Conditions Dr Máirtín Ó Maoláin Department of General Practice Presented by Dr. Abeer Khalaf Family Medicine Lecturer GP Department- RCSI Bahrain FFP1 MODULE LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaboration, interventions) as part of a team 2....

Living with Chronic Conditions Dr Máirtín Ó Maoláin Department of General Practice Presented by Dr. Abeer Khalaf Family Medicine Lecturer GP Department- RCSI Bahrain FFP1 MODULE LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaboration, interventions) as part of a team 2. Describe global trends in morbidity and mortality using Global Burden of disease study data 3. Display knowledge of the basic framework of the Calgary Cambridge Model in communication 4. Discuss the application of professionalism, leadership and resilience (i.e. the constructs of Personal and Professional Identity) to manage self and engage with patients, colleagues and communities. 5. Describe the biomolecular, cellular and biochemical fundamental to life, and the principles of pharmacology 6. Describe the social determinants of health and the breadth and function of the public health and health promotion role. 7. Explain the pathological and immunological processes underlying disease 8. Identify the characteristics of medically important microbiological organisms and pathogenesis of bacterial infections 9. Explain the principles of microbiological diagnostic investigation 10. Explain psychological principles of maintaining health. LEARNING OUTCOMES 1. Identify the challenges faced by patients living with a chronic condition 2. Discuss the impact that a chronic condition can have on a patient’s family ANGELA Angela is 70 years old and recently moved to Dublin Angela is a new patient to be who closerrecently to her sonmoved and to the area to be closer to her son and his his family. family. She has a history of congestive cardiac failure She is 70 years old and has atohistory secondary of a myocardial infarction. congestive cardiac failure She also to secondary toldayou when you first met her that myocardial infarction. she is hard of hearing. She has been hospitalized She hastwice within the been hospitalised twice within last 6 months for worsening ofthe last 6 heart failure months for worsening of and has a leg ulcer which is painful heart failure and has a leg ulcer which is painful. ANGELA She is extremely diligent about taking her five medications. She is mobile and lives alone with her two cats, Felix and Garfield, but sometimes she forgets certain things. The receptionist says she has come to see the GP for a repeat prescription. When Angela presents, she says she currently has shortness of breath. She is an ex-smoker. LECTURE OUTLINE What? Why? How?  Chronic conditions/disease/illness  Impact of chronic illness on patients  Impact of chronic illness on families PATIENT-DR INTERACTION & CHRONIC ILLNESS Patie Physici nt an Disease Knowledge Illness Understandi ng Proximal Social & Cultural ContextProximal Social & Cultural Context Distal Social & Cultural Context WHAT IS CHRONIC ILLNESS/DISEASE? Before we consider the above, how do we define health? WHAT IS CHRONIC ILLNESS/DISEASE? Before we consider the above, how do we define health? ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ World Health Organization (1946). Constitution of the World Health Organization. Basic Documents, Geneva World Health Organization. INTERSECTION OF DISEASE AND ILLNESS What is disease? Abnormality of structure and/or function of the mind/body Diagnosed through history, physical examination +/- investigations What is illness? Personal and subjective experience of disease Feelings, thoughts and altered function of the sick person  EXAMPLES OF CHRONIC DISEASES/ ILLNESSES? Cardiovascular illness/  Ischaemic heart disease disease  Arrhythmias  Heart failure * Consider a  Hypertension case when a patient has no Respiratory  COPD symptoms- but illness/  Asthma meets the disease diagnostic  Osteoarthritis criteria for a Musculoskeletal disease?  Rheumatoid Arthritis disease  Osteoporosis  Stroke Neurological  MS disease  Parkinson's Disease  INTERSECTION OF DISEASE AND ILLNESS Asymptomatic disease Symptomatic disease Disease Illness Feeling unwell  INTERSECTION OF DISEASE AND ILLNESS Asymptomatic disease Symptomatic disease ICD-11 DSM-V Disease Bio-psycho-social Heart failure Pain Decompensated liver Nausea Illness disease Stress Moderate depressive Family problems disorder without Social difficulties psychosis Osteoporosis Hypertension Feeling unwell Chronic kidney disease Consider these ‘diseases’  WHAT IS CHRONIC DISEASE/ILLNESS? Chronic Acute Number of systems Often multiple Usually one involved (*multimorbidity) Resolution/Cure Uncertain future Responds to treatment Care and resources More required to Less required as it is approach a normal temporary lifestyle Coping strategies ? ? timorbidity is commonly defined as the co-existence of two or more chronic ditions in an individual HOW TO LEARN ABOUT LIVING WITH A CHRONIC ILLNESS? Reflecting on:  Your own illness experiences  Illness experiences of those close to you  Narratives of illness in books or film  Experiences of patients you meet ANGELA Angela is 70 years old and recently moved to Dublin Angela is a new patient to be who closerrecently to her sonmoved and to the area to be closer to her son and his his family. family. She has a history of congestive cardiac failure She is 70 years old and has atohistory secondary of a myocardial infarction. congestive cardiac failure She also to secondary toldayou when you first met her that myocardial infarction. she is hard of hearing. She has been hospitalized She hastwice within the been hospitalised twice within last 6 months for worsening ofthe last 6 heart failure months for worsening of and has a leg ulcer which is painful heart failure and has a leg ulcer which is painful. ANGELA She is extremely diligent about taking her five medications. She is mobile and lives alone with her two cats, Felix and Garfield, but sometimes she forgets certain things. The receptionist says she has come to see the GP for a repeat prescription. When Angela presents, she says she currently has shortness of breath. She is an ex-smoker. HOW TO LEARN ABOUT LIVING WITH A CHRONIC ILLNESS? HOW WOULD YOU DESCRIBE ANGELA’S SITUATION?  What are her chronic conditions?  Does she have multimorbidity?  What are the acute conditions?  What do you want to know more about? LECTURE OUTLINE What? Why? How?  Chronic illness  Impact of chronic illness on patients  Impact of chronic illness on families WHAT IMPACT DOES CHRONIC ILLNESS HAVE ON THE PATIENT?. WHAT IMPACT DOES CHRONIC ILLNESS HAVE ON THE PATIENT? Biological/Functional – Eating, sleeping, hygiene, mobility, etc Psychological – Stress, denial, anxiety, depression, etc Social – Role with family, work, friends WHAT IMPACT DOES CHRONIC ILLNESS HAVE ON THE PATIENT? Coming to terms with an illness: - denial vs acceptance - being cared for vs being independent - forced to realise not immune to disease - lack of control, terror, depression, identity crisis - inner strength, new meaning, mastery, support WHY EXPLORE THE IMPACT OF CHRONIC ILLNESS ON THE PATIENT? Treatment Burden:  Understanding and self-managing their conditions  Attending multiple appointments  Multiple health professionals – risk of fragmented care  Managing complex medication regimens  "endless struggle" = how some patients describe it WHAT IMPACT DOES CHRONIC ILLNESS HAVE ON THE PATIENT? IMPACT OF MULTIMORBIDITY Increased psycholog ical distress Decrease Future d quality uncertain of life Polypharm acy increasing More adverse drug hospital events & admission drug s interaction s Longer Functiona hospital l decline stays WHY EXPLORE THE IMPACT OF CHRONIC ILLNESS ON THE PATIENT?  Understand the patient's experience of their condition – increase empathy  Builds rapport and encourages positive patient-doctor relationship – patient sees you care  Increased adherence with management plan e.g. concordance with medications  Patient and physician satisfaction HOW TO EXPLORE THE IMPACT OF CHRONIC ILLNESS ON THE PATIENT? In addition to asking about symptoms, ask about….  Ideas – beliefs about the cause of illness(es)  Concerns – worries about the illness(es)  Expectations – anticipated assistance for the illness(es)  Effects – the effect of illness(es) on the patient’s life ANGELA Ideas – who Angela is a new patient “I forget because recently moved I’m tired” to the area to be closer to her son and his family. Concerns – “I don’t want to be a burden to my children” She is 70 years old and has a history of congestive cardiacExpectations failure secondary – “I justto a want to get some sleep” myocardial infarction. Effects She has been hospitalized twice Ulcer pain withinsleep interrupts the last 6 months for worsening of heart failure and appetite which and has a leg ulcer Limited is painful mobility due to SOB HOW TO EXPLORE THE IMPACT OF CHRONIC ILLNESS ON THE PATIENT? NOW THAT YOU HAVE EXPLORED ICEE WITH ANGELA HOW HAS YOUR UNDERSTANDING CHANGED? Further exploration of Angela’s sleep problems reveal: Angela is taking diuretic tablets (for her cardiac failure) before bed and this is increasing her nocturia. What can be done? Angela takes pain tablets in the morning and noon for her ulcer which decrease her appetite and make her tired. What can be done? How might things have gone differently if the doctor LECTURE OUTLINE What? Why? How?  Chronic illness  Impact of chronic illness on patients  Impact of chronic illness on families IMPACT OF CHRONIC ILLNESS ON THE FAMILY Patie Physici nt an Disease Knowledge Illness Understandi ng Proximal Social & Cultural ContextProximal Social & Cultural Context Distal Social & Cultural Context IMPACT OF CHRONIC ILLNESS ON THE FAMILY Patie Physici nt an Disease Knowledge Illness Understandi ng FAMILY AND Proximal Social & Cultural Context Proximal Social & Cultural Context FRIENDS Distal Social & Cultural Context WHAT IMPACT DOES CHRONIC ILLNESS HAVE ON THE PATIENT’S FAMILY? WHY EXPLORE THE IMPACT OF CHRONIC ILLNESS ON THE PATIENT’S FAMILY?  Family can provide further insight into patient illness experience  Often family can be main caregivers to patients with chronic illness – understand and support them  Approx 500,000 family carers in Ireland  Approx 67,000 = 10 to 17 years old  Some insights into their experiences in next slides https://familycarers.ie/about-us/family-caring-in-ireland/caring-by-numbers IMPACT OF CHRONIC ILLNESS ON THE PATIENT’S FAMILY? https://familycarers.ie/ media/2545/family-carers- ireland-state-of-caring- IMPACT OF CHRONIC ILLNESS ON THE PATIENT’S FAMILY? https://familycarers.ie/media/2545/family-carers-ireland-state-of-caring-2022.pdf WHAT IMPACT DOES CHRONIC ILLNESS HAVE ON THE PATIENT’S FAMILY? 1) Relationship change - Partner, parent or child role changes - Difficult relationships may worsen 2) Increased responsibility/ stress - First port-of-call in emergencies - Balancing other roles/own health 3) Promoting independence to accepting dependence - Overprotection - Consider risk of abuse and/or neglect HOW TO EXPLORE THE IMPACT OF CHRONIC ILLNESS ON THE PATIENT’S FAMILY? Asking the family about….  Ideas – beliefs about the cause of illness(es)  Concerns – worries about the illness(es)  Expectations – anticipated assistance for the illness(es)  Effects – the effect of illness(es) on the patient’s and family’s life ANGELA ANGELA'S SON PHONED TO DISCUSS HIS MUM – CONSENT FROM ANGELA TO DISCUSS CARE Ideas – “I think she might be depressed” Concerns – “I’m worried about her living on her own” Expectations – “Can you encourage her to move in with us?” Effects Driving her to appointments HOW TO EXPLORE THE IMPACT OF CHRONIC ILLNESS ON THE PATIENT? NOW THAT YOU HAVE EXPLORED ICEE WITH ANGELA’S FAMILY HOW HAS YOUR UNDERSTANDING CHANGED? Do Angela and her family have the same expectations? Do you have any concerns about the family? What other team members could help support Angela and her family? How might things have gone differently if the doctor did not explore the impact on Angela’s family? LECTURE OUTLINE What? Why? How? ✓ Chronic illness Impact of chronic illness on ✓ patients ✓ Impact of chronic illness on families Any questions or comments? THANK YOU