Anticipatory Care for Long Term Conditions in Physiotherapy: Difference between revisions
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=== Stats & Facts === | === Stats & Facts === | ||
*[[File:Proportional mortality.jpg|thumb]]Long term conditions are responsible for 41 million deaths each year , accounting for 70% of all deaths around the globe<ref name=":0" /> The number is estimated to reach 52 million by 2030<ref>Kelland K. Chronic disease to cost $47 trillion by 2030: WEF. Reuters 2011. Available from: https://www.reuters.com/article/us-disease-chronic-costs-idUSTRE78H2IY20110918 (Accessed 20 May 2020)</ref>. | *[[File:Proportional mortality.jpg|thumb]]Long term conditions are responsible for 41 million deaths each year , accounting for 70% of all deaths around the globe<ref name=":0" /> The number is estimated to reach up to 52 million by 2030<ref>Kelland K. Chronic disease to cost $47 trillion by 2030: WEF. Reuters 2011. Available from: https://www.reuters.com/article/us-disease-chronic-costs-idUSTRE78H2IY20110918 (Accessed 20 May 2020)</ref>. | ||
* | * According to the World Health Organization, Cardiovascular diseases account for most NCDs deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9 million), and diabetes (1.6 million)<ref name=":0" /> | ||
* 15% of young adults aged 11-15 have an | * 15% of young adults aged 11-15 have an LTCs<ref name=":1">Pharmaceutical Services Negotiating Committee. Essential facts, stats and quotes relating to long-term conditions. Available from:http://psnc.org.uk/services-commissioning/essential-facts-stats-and-quotes-relating-to-long-term-conditions/ (accessed 20 May 2020)</ref> | ||
* 15 million of all deaths attributed to NCDs occur between the ages of 30 and 69 years<ref name=":0" /> | * 15 million of all deaths attributed to NCDs occur between the ages of 30 and 69 years<ref name=":0" /> | ||
* In Scotland, LTCs account for 80% of all GP consultations and they twice as likely to be admitted to | * In Scotland, LTCs account for 80% of all GP consultations and they are twice as likely to be admitted to hospitals<ref>Scotland A. Managing long-term conditions. Edinburgh: Audit Scotland. 2007.</ref> | ||
* In England, It's estimated that only 59% of people living with LTCs are in work, compared with 72% of the general population<ref name=":1" />. | * In England, It's estimated that only 59% of people living with LTCs are in work, compared with 72% of the general population<ref name=":1" />. | ||
* NCDs disproportionately affect people in low- and middle-income countries<ref name=":0" /> | * NCDs disproportionately affect people in low- and middle-income countries<ref name=":0" /> | ||
== Causes and Risk Factors == | == Causes and Risk Factors == | ||
Harmful behavior such as sedentary lifestyle, unhealthy diets, exposure to tobacco smoke or the harmful use of alcohol are all contributing factors to LTCs<ref name=":0" />. | |||
<u>The World Health | <u>The World Health Organization classified LTCs contributing factors into two categories</u><ref name=":0" /><u>:</u> | ||
'''Modifiable | '''Modifiable behavioral risk factors:''' | ||
* Tobacco (including second-hand smoking) | * Tobacco (including second-hand smoking) | ||
* Excess salt/sodium intake | * Excess salt/sodium intake | ||
| Line 44: | Line 44: | ||
Long term conditions are associated with multimorbidites that impact the quality of life of the individual and burdens the healthcare system. | Long term conditions are associated with multimorbidites that impact the quality of life of the individual and burdens the healthcare system. | ||
People with | People with multimorbidities have poorer functional status, quality of life,working capacity and health outcomes than are those without multimorbidity<ref>Prevalence, expenditures, and complications of multiple chronic conditions in the elderly.''Arch Intern Med.'' 2002; 162: 2269-2276</ref>. | ||
LTCs can negatively affect the individual's mobility and result in '''social''' consequences such as home-bounding, self-care disability and bed-bounding, the ultimate consequences being social isolation, family conflicts and even stigma<ref>Roca M, Mitu O, Roca IC, Mitu F. Chronic Diseases--Medical and Social Aspects. Revista de Cercetare si Interventie Sociala. 2015 Jun 1;49.</ref>. | LTCs can negatively affect the individual's mobility and result in '''social''' consequences such as home-bounding, self-care disability and bed-bounding, the ultimate consequences being social isolation, family conflicts and even stigma<ref>Roca M, Mitu O, Roca IC, Mitu F. Chronic Diseases--Medical and Social Aspects. Revista de Cercetare si Interventie Sociala. 2015 Jun 1;49.</ref>. | ||
Coping with the long term conditions might be difficult and | Coping with the long term conditions might be difficult and can be '''stressing or disabling''' . Lost of interest, feeling guilty or responsible and low self-esteem can worsen the development of the disease. The person might also lose the ability to engage in activities that bring a sense of meaning and purpose to life<ref>Roberts L. Psychological Aspects of Chronic Illness. Sheffield APT.Available from: https://www.sth.nhs.uk/clientfiles/File/Mental%20Health%20Awareness%20presentation%20-%20based%20on%20Maria%20and%20Ian's%20POTS%20training.pdf (Accessed 20 May 2020)</ref>. | ||
The economic burden of LTCs is significant. The United Nations has estimated that the cumulative loss to the global economy could reach $47 trillion by 2030 due to LTCs<ref>Institute for Global Health Sciences. Non-communicable Disease Could Cost Global Economy $47 Trillion by 2030. Available from:https://globalhealthsciences.ucsf.edu/news/non-communicable-disease-could-cost-global-economy-47-trillion-2030 (Last | The economic burden of LTCs is significant. The United Nations has estimated that the cumulative loss to the global economy could reach $47 trillion by 2030 due to LTCs<ref>Institute for Global Health Sciences. Non-communicable Disease Could Cost Global Economy $47 Trillion by 2030. Available from:https://globalhealthsciences.ucsf.edu/news/non-communicable-disease-could-cost-global-economy-47-trillion-2030 (Last Accessed 20 May 2020)</ref>. | ||
The estimated cost of Long Term Conditions care in the UK was at £320 million in 2017<ref name=":2" />. | The estimated cost of Long Term Conditions care in the UK was at £320 million in 2017<ref name=":2" />. | ||
== Healthcare Policies == | == Healthcare Policies == | ||
The role of | The role of behavioral factors in developing LTCs is significant. Altering these factors can help in the prevention and management of these conditions. | ||
The healthcare model is supporting the prevention and anticipatory care of LTCs by preventive measures, health promotion and encouraging patient's advocacy<ref name=":2" />. | The healthcare model is supporting the prevention and anticipatory care of LTCs by preventive measures, health promotion and encouraging patient's advocacy<ref name=":2" />. | ||
Making every contact count (MECC) is an approach to | Making every contact count (MECC) is an approach to behavior change that encourages healthcare professionals to utilize day to day interactions to promote changes in behavior that have a positive effect on the health and well being of individuals, communities and populations. | ||
MECC focuses on | MECC focuses on lifestyle changes that can influence the health of the individuals such as: | ||
* Stopping smoking | * Stopping smoking | ||
* Limit alcohol drinking to the recommended limits | * Limit alcohol drinking to the recommended limits | ||
| Line 67: | Line 67: | ||
* Physical Activity | * Physical Activity | ||
* Keeping healthy weight | * Keeping healthy weight | ||
* Mental health and | * Mental health and well being | ||
Read more about MECC [https://www.makingeverycontactcount.co.uk/ here] | Read more about MECC [https://www.makingeverycontactcount.co.uk/ here]. | ||
The MECC model was integrated in the physiotherapy practice by | The MECC model was integrated in the physiotherapy practice by several organizations and had successful outcomes on improving the health conversation and promoting physical activities<ref>Cooper-Ryan AM, Ure CM. Making Every Contact Count: Evaluation of the use of MECC within the outpatient MSK Physiotherapy service and Bury Integrated MSK Service at Fairfield General Hospital, part of the Bury and Rochdale Care Organisation which is part of the Northern Care Alliance Group.</ref>. | ||
== Physiotherapy and health Promotion == | == Physiotherapy and health Promotion == | ||
'''Physiotherapy | '''Physiotherapy have an important role in the prevention of LTCs throughout different stages'''<ref name=":2" />''':''' | ||
# Medial Prevention by | # Medial Prevention by utilizing different intervention in cardiac rehabilitation for cardiac diseases | ||
# | # Behavioral prevention by supporting individuals and encourage healthy lifestyle measures | ||
# Social/ | # Social/environmental by education on environmental measures and supporting occupational policies | ||
'''Making | '''Making Every Contact Count model can be integrated in the physiotherapy practice on four stages'''<ref name=":2" />''':''' | ||
# Screening of health status and identifying areas of change | # Screening of health status and identifying areas of change | ||
# Agenda setting by discussing needed changes with the patient | # Agenda setting by discussing needed changes with the patient | ||
# Readiness to change by discussing and assessing | # Readiness to change by discussing and assessing obstacles to change | ||
# Goal setting using [https://physio-pedia.com/Goal_Setting_in_Rehabilitation SMART goals] | # Goal setting using [https://physio-pedia.com/Goal_Setting_in_Rehabilitation SMART goals] | ||
[[File:SMART-goals.png|none|thumb|500x500px]] | [[File:SMART-goals.png|none|thumb|500x500px]] | ||
'''Mental readiness can be an | '''Mental readiness can be an obstacle to lifestyle changes. There are six stages of mental preparation that physiotherapists need to be aware of to help their patients improving their health and well being'''<ref name=":2" />''':''' | ||
* | * Precontemplation: patient is aware of the problem but not willing to take an action | ||
* Contemplation: patient is aware of the road to change | * Contemplation: patient is aware of the road to change | ||
* Preparation: physiotherapists can help by using SMART goals | * Preparation: physiotherapists can help by using SMART goals | ||
* Action plan: based on identified goals | * Action plan: based on identified goals | ||
* | * Maintenance: where most people fail. Physiotherapists can help by encouraging and supporting patient's commitment | ||
* Relapse: if | * Relapse: if happens, physiotherapists can help by re assessing and setting new goals | ||
[[File:Transtheoretical Model-The Stages of Change.png|none|thumb|600x600px]] | [[File:Transtheoretical Model-The Stages of Change.png|none|thumb|600x600px]] | ||
=== Self-management<ref name=":2" />: === | === Self-management<ref name=":2" />: === | ||
Self-management is a powerful tool that enables | Self-management is a powerful tool that enables patients to take control of their treatment by actively cooperating to take actions toward their recovery. | ||
'''<u>The role of physiotherapy in self-management:</u>''' | '''<u>The role of physiotherapy in self-management:</u>''' | ||
* support | * support patients to get proper diagnosis and understand the pathology clearly | ||
* communicating with patients using open-ended questions | * communicating with patients using open-ended questions that encourage patients to engage and reflect on their lifestyle and behavior | ||
* setting goals to show patients their potentials | * setting goals to show patients their potentials | ||
* | * Utilize digital/telehealth: to sympathize and connect with patients easily especially when traveling/commuting is challenging. The availability of videos and pictures can make treatment simpler and easy to understand. Smart phone applications offer easy and accessible interface and offer a range of technologies that facilitate participation in the treatment plan such as exercise templates, online agenda, feedback in real time and monitoring vitals. However, the use of digital health has some downside such as the risk of breaching data and compromising patient's privacy and the associated high cost especially in low resource settings. | ||
* Promoting the use of self-testing and vital signs kits for | * Promoting the use of self-testing and vital signs kits for Diabetes and Blood Pressure | ||
* | * Utilization of screening tests to help identify risks such as [[Six Minute Walk Test / 6 Minute Walk Test|walking speed test]] and [https://physio-pedia.com/Timed_Up_and_Go_Test_(TUG) get up and go test] | ||
* | * Working in integrated care team and using an effective referral scheme to connect patients with other services and direct them to support when needed | ||
== References == | == References == | ||
Revision as of 22:45, 20 May 2020
Original Editor - Mariam Hashem
Top Contributors - Mariam Hashem, Jess Bell, Kim Jackson, Lucinda hampton, Olajumoke Ogunleye, Tony Lowe, Tarina van der Stockt and Vidya Acharya
Introduction[edit | edit source]
Long term conditions (LTCs), also known as chronic diseases or Non-communicable diseases (NCDs)[1], are defined as physical and mental health condition that require management over a long period of time.[2]
Examples:
- Heart disease
- Stroke
- Cancer
- Diabetes
- Chronic lung disease such as chronic obstructive pulmonary disease and asthma
Stats & Facts[edit | edit source]
- Long term conditions are responsible for 41 million deaths each year , accounting for 70% of all deaths around the globe[1] The number is estimated to reach up to 52 million by 2030[3].
- According to the World Health Organization, Cardiovascular diseases account for most NCDs deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9 million), and diabetes (1.6 million)[1]
- 15% of young adults aged 11-15 have an LTCs[4]
- 15 million of all deaths attributed to NCDs occur between the ages of 30 and 69 years[1]
- In Scotland, LTCs account for 80% of all GP consultations and they are twice as likely to be admitted to hospitals[5]
- In England, It's estimated that only 59% of people living with LTCs are in work, compared with 72% of the general population[4].
- NCDs disproportionately affect people in low- and middle-income countries[1]
Causes and Risk Factors[edit | edit source]
Harmful behavior such as sedentary lifestyle, unhealthy diets, exposure to tobacco smoke or the harmful use of alcohol are all contributing factors to LTCs[1].
The World Health Organization classified LTCs contributing factors into two categories[1]:
Modifiable behavioral risk factors:
- Tobacco (including second-hand smoking)
- Excess salt/sodium intake
- Alcohol use
- Lack of or insufficient physical activity
Metabolic risk factors:
- Hypertension
- overweight/obesity
- hyperglycemia (high blood glucose levels)
- hyperlipidemia (high levels of fat in the blood)
Impacts on Individual and society[edit | edit source]
Long term conditions are associated with multimorbidites that impact the quality of life of the individual and burdens the healthcare system.
People with multimorbidities have poorer functional status, quality of life,working capacity and health outcomes than are those without multimorbidity[6].
LTCs can negatively affect the individual's mobility and result in social consequences such as home-bounding, self-care disability and bed-bounding, the ultimate consequences being social isolation, family conflicts and even stigma[7].
Coping with the long term conditions might be difficult and can be stressing or disabling . Lost of interest, feeling guilty or responsible and low self-esteem can worsen the development of the disease. The person might also lose the ability to engage in activities that bring a sense of meaning and purpose to life[8].
The economic burden of LTCs is significant. The United Nations has estimated that the cumulative loss to the global economy could reach $47 trillion by 2030 due to LTCs[9].
The estimated cost of Long Term Conditions care in the UK was at £320 million in 2017[2].
Healthcare Policies[edit | edit source]
The role of behavioral factors in developing LTCs is significant. Altering these factors can help in the prevention and management of these conditions.
The healthcare model is supporting the prevention and anticipatory care of LTCs by preventive measures, health promotion and encouraging patient's advocacy[2].
Making every contact count (MECC) is an approach to behavior change that encourages healthcare professionals to utilize day to day interactions to promote changes in behavior that have a positive effect on the health and well being of individuals, communities and populations.
MECC focuses on lifestyle changes that can influence the health of the individuals such as:
- Stopping smoking
- Limit alcohol drinking to the recommended limits
- Healthy eating
- Physical Activity
- Keeping healthy weight
- Mental health and well being
Read more about MECC here.
The MECC model was integrated in the physiotherapy practice by several organizations and had successful outcomes on improving the health conversation and promoting physical activities[10].
Physiotherapy and health Promotion[edit | edit source]
Physiotherapy have an important role in the prevention of LTCs throughout different stages[2]:
- Medial Prevention by utilizing different intervention in cardiac rehabilitation for cardiac diseases
- Behavioral prevention by supporting individuals and encourage healthy lifestyle measures
- Social/environmental by education on environmental measures and supporting occupational policies
Making Every Contact Count model can be integrated in the physiotherapy practice on four stages[2]:
- Screening of health status and identifying areas of change
- Agenda setting by discussing needed changes with the patient
- Readiness to change by discussing and assessing obstacles to change
- Goal setting using SMART goals
Mental readiness can be an obstacle to lifestyle changes. There are six stages of mental preparation that physiotherapists need to be aware of to help their patients improving their health and well being[2]:
- Precontemplation: patient is aware of the problem but not willing to take an action
- Contemplation: patient is aware of the road to change
- Preparation: physiotherapists can help by using SMART goals
- Action plan: based on identified goals
- Maintenance: where most people fail. Physiotherapists can help by encouraging and supporting patient's commitment
- Relapse: if happens, physiotherapists can help by re assessing and setting new goals
Self-management[2]:[edit | edit source]
Self-management is a powerful tool that enables patients to take control of their treatment by actively cooperating to take actions toward their recovery.
The role of physiotherapy in self-management:
- support patients to get proper diagnosis and understand the pathology clearly
- communicating with patients using open-ended questions that encourage patients to engage and reflect on their lifestyle and behavior
- setting goals to show patients their potentials
- Utilize digital/telehealth: to sympathize and connect with patients easily especially when traveling/commuting is challenging. The availability of videos and pictures can make treatment simpler and easy to understand. Smart phone applications offer easy and accessible interface and offer a range of technologies that facilitate participation in the treatment plan such as exercise templates, online agenda, feedback in real time and monitoring vitals. However, the use of digital health has some downside such as the risk of breaching data and compromising patient's privacy and the associated high cost especially in low resource settings.
- Promoting the use of self-testing and vital signs kits for Diabetes and Blood Pressure
- Utilization of screening tests to help identify risks such as walking speed test and get up and go test
- Working in integrated care team and using an effective referral scheme to connect patients with other services and direct them to support when needed
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 World Health Organization. Noncommunicable diseases. Available from:https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases (Accessed 20 May 2020)
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Haentjens M. Anticipatory Care for Long Term Conditions in Physiotherapy. Physioplus course 2020
- ↑ Kelland K. Chronic disease to cost $47 trillion by 2030: WEF. Reuters 2011. Available from: https://www.reuters.com/article/us-disease-chronic-costs-idUSTRE78H2IY20110918 (Accessed 20 May 2020)
- ↑ 4.0 4.1 Pharmaceutical Services Negotiating Committee. Essential facts, stats and quotes relating to long-term conditions. Available from:http://psnc.org.uk/services-commissioning/essential-facts-stats-and-quotes-relating-to-long-term-conditions/ (accessed 20 May 2020)
- ↑ Scotland A. Managing long-term conditions. Edinburgh: Audit Scotland. 2007.
- ↑ Prevalence, expenditures, and complications of multiple chronic conditions in the elderly.Arch Intern Med. 2002; 162: 2269-2276
- ↑ Roca M, Mitu O, Roca IC, Mitu F. Chronic Diseases--Medical and Social Aspects. Revista de Cercetare si Interventie Sociala. 2015 Jun 1;49.
- ↑ Roberts L. Psychological Aspects of Chronic Illness. Sheffield APT.Available from: https://www.sth.nhs.uk/clientfiles/File/Mental%20Health%20Awareness%20presentation%20-%20based%20on%20Maria%20and%20Ian's%20POTS%20training.pdf (Accessed 20 May 2020)
- ↑ Institute for Global Health Sciences. Non-communicable Disease Could Cost Global Economy $47 Trillion by 2030. Available from:https://globalhealthsciences.ucsf.edu/news/non-communicable-disease-could-cost-global-economy-47-trillion-2030 (Last Accessed 20 May 2020)
- ↑ Cooper-Ryan AM, Ure CM. Making Every Contact Count: Evaluation of the use of MECC within the outpatient MSK Physiotherapy service and Bury Integrated MSK Service at Fairfield General Hospital, part of the Bury and Rochdale Care Organisation which is part of the Northern Care Alliance Group.
