Long term conditions Essay

Long- enclosure causations alike cognize as chronic diseases or non-communicable diseases subscribe to been defined by the demesne health Organization (WHO, 2005, p.35) as conditions that have origins at young get alongs distri howevere decades to be fully established, with their long duration, requiring a long term and organized turn up to preaching. Plans to transform interest for uncomplainings with long-run conditions be based on continuing to maintain focus on azoic intervention and legal profession supporting integrated services sh solely aid the perseverings and the public have a clear set of rights and patients in turn shall help the wellness c ar by undertaking the necessary steps, to take good care of their take wellness promoting a preventative, bulk- centred, and productive care to be delivered ( long Britain. subdivision of wellness, 2009). film director General of WHO expressed that, the lives of far too m whatever people in the world are beingne ss blighted and cut short by chronic diseases, this is avery serious situation, both for public health and for the societies and economies affected (WHO, 2005, p. VII), which has raised a need for long term conditions to be managed differently. Goodwin et al (2010, p.61) report that it was recognised, if patients with long-term conditions were managed launchively in the community, they would remain comparatively stable and enjoy a tincture of life free from snitch crises or observed growings in hospital visits. chronic diseases have pose a heavy burden on the health care with charter for services and cost for treatment the economic cost levels incurred directly by the health care and indirectly by the individuals has also increase, and also change magnitude work of hospital resources, raising need to manage the differently (Canada. part of health and Community Services, 2011, p.7).They are succession-consuming and some do not require the expertise and skill of a physicia n, but rather, may be managed by other members of the health care team (Canada. Ontario Medical Association, 2009, p.1). Chronic conditions have an effect on utilisationplaces as regards productivity losings, where modifications have to be made by employers who attain workers with long-term conditions so there is a need to manage them differently (Canada. discussion section of health and Community Services, 2011, p.7).Great Britain. Department of Health (2012) published a policy to support the direction of long term conditions improving smell of life for patients with long term conditions. Majority of the health care trunks of middle-income countries, including Malaysia, are organised slightly models of healthcare developed in western countries, such systems are clearly at odds when dealing with long-term and continuing illness that require collaboration across health care sectors and where patient demeanor change forms the patriarchal focus (Yasin et al, 2012, p.3). Mala ysia is now implementing the Innovative Care for Chronic Conditions Model (ICCC), for it was developed, recognizing the challenges of the under-resourced and non-integrated health systems in low-and-middle income countries but still holds focus on encouraging behaviour change at an individual level by means of improving self- counsel (Yasin et al, 2012, p.4).Managing long-term conditions requires severalize principles to be utilise forhealth care to remain center with the plans to transform care the Department of Health, Social Services and Public rubber eraser (Great Britain. Department of Health, Social Services and Public Safety, 2012, p.13) identifies six key principles that may be used as guidelines for managing long-term conditions and these imply working in partnership with the patients and their carers, supporting self-management, avail appropriate and timely record-based information to service-users and their carers, sanction personalised aid for patients to manage their medicines, recognising carers as partners in planning and voice communication of services, services should be patient-centred, and flexible and integrated services across all sectors.In this assignment, a scenario of a patient diagnosed with Rheumatoid Arthritis three months ago, is outlet to be discuss, regarding examination findings outlined in the pro-forma her name is Marjory 32 age old, married and a mother of two, works as a secretary. It is her archetypal physiotherapy session, and she is receiving spry treatment, and shall be introduced to self-management guidelines that are to help her manage her condition at home.Rheumatoid arthritis (RA) is an inflammatory, autoimmune disease that causes distressingness in the neck, vocalise stiffness curiously in the morning, and loss of function it can occur at any age but is more common in persons over the age of 30 years and affects women more often than men (Australia. The Department of Health and Ageing, 2009, p.1). R A is a systematic disease that affects the whole body knock pain and swelling manifest, leading to structural deformities and disability, cavictimization a lessening in joint movement and muscle use this happens because the immune system attacks the synovium first, with which the synovial membrane becomes thick and inflamed, resulting in unwanted create from raw stuff growth, but the most affected joints are particularly those of the wrists, march ons and feet (Australia. The Department of Health and Ageing, 2009, p.3-4). Goal-setting wait on is required when managing RA patients a formal process where a physiotherapist together with the patient formulates the rehabilitation goals which need to be specific, measurable, achievable, realistic/relevant and timed, i.e. meeting the criteria for SMART principle (Meesters et al, 2013, p.1).Physiotherapy management of RA uses a comprehensive approach which consists of a combination of education, solve and pain relief agents, with the emphasis varying depending on clinical necessarily identified, so the physiotherapist and patient discuss coming to an agreement in regards to setting goals (The National Collaborating Centre for Chronic Condition (NCCCC), 2009, p.77). Physiotherapy aims to melt off pain and stiffness, prevent deformity and maximise function, independence and quality of life, which Marjory as needs (NCCCC, 2009, p. 77). Kavuncu and Evcik (2004, p.1) assert that successful management involves educating patients and informing them about the mean treatment modalities that are going to be used and their effects to the patients identified problems.It was identified that Marjory had residual swelling around her hands, but no heat on palpation and the range of motion (read-only memory) had also reduced paraffin wax therapy and hand exercises are the interventions chosen. Kacunvu and Evcik (2004, p.2) recommend using heat therapy before exercise for maximum benefit and applications are recommended for 1020 minutes at one time or twice a day. methane series wax therapy has a short term symptomatic relief of pain and stiffness at the hands the use of moist heat is think to increase blood flow to the area, reduce pain and improve ROM (Welch et al, 2011, p.2).Recent evidence shows positive results for paraffin wax baths combined with hand exercises for arthritic hands on objective measures of ROM, pinch function, grip strength, pain on non-resisted motion, stiffness compared to control after four consecutive weeks of treatment (Welch et al, 2011, p.2). Despite paraffin wax therapy having benefits, its heat effects may increase inflammation, thus increasing swelling of the synovial membrane, so both joint and skin temperature elevate following superficial heating, which is a dis expediency to using heat therapy as an intervention, because RA patients often have unstable vascular re processs following exposure to heat (Hayes, pg.255, 2006). some other identified problem on Marjory was the swelling on the knees with heat on palpation, cold therapy is preferred for prompt joints where intra-articular heat increase is uncraved the physiologic effects ofcold therapy admit an abrupt drop in skin temperature, and a slow deny in temperatures within the muscles and joints the recommended application time is 20 minutes to reduce synovial blood flow in patients with arthritis (Demoulin and Vanderthommen, 2011, p.117). Cold therapy is advocated to be applied intermittently rather than continuous, for the optimal parameters each session should last 25 to 30 minutes, which is the time thought to be mandatory to substantially return temperature, blood flow, and metabolism (Demoulin and Vanderthommen, 2011, p.118).After cold therapy application, then TENS will be applied on Marjorys knees, for it returns pain and inflammation, and also reduces stiffness its physiological effect of stimulation of the large sensory fibres prevents impulses from the smaller pain fibres f rom being transmitted in the ascending tracks in the spinal cord decrease inflammation and joint volume will contrive an analgesic effect (Hayes, 2006, p.257). The burst-mode is recommended for it has both the high (70100 Hz), and low (34 bursts per second) frequency modes the advantage of burst-mode TENS is the greater comfort of the current, recommended treatment time is 30 minutes, only once per day for several weeks (Hayes, 2006, p. 257). The disadvantage of TENS, is the discomfort that arises from skin irritation through the electrode couplant from the electricity, and a study reported that an RA patient developed paresthesias which increased pain following heat and TENS, these effects were delayed, so RA patients should be monitored closely (Hayes, 2006, p. 257).In early disease of RA, patient education is a foundation of all rehabilitation interventions however, using cognitive behavioural approach delivered at the appropriate time which is after active treatment, in compa nionship to promote long-term adherence to management strategies rather than an education-only approach (Luqmani et al, 2006, p.5). look suggests that changing of illness perceptions and the use of coping strategies have a world-shattering influence on psychological well- being, health-seeking behaviours, adherence and treatment outcome on rheumatoid arthritis patients (Dures and Hewlett, 2012, p.553).Rehabilitation is targets managing the consequences of disease, so there are other strategies that are to be applied for long-term remission for everyone with RA (Hammond A, pg.135, 2004) for which Marjory shall be empower to manage her condition.Self-management training does plays a role with patient knowledge gain, aiming to give patients the strategies and tools necessary to make daily decisions to cope with the disease patients involvement in the management of their care helps to improve self-confidence, desirable behaviour and improved structural status (Vliet Vlieland, 2007, p.1400). Self-efficacy is a component that may influence Marjory to have a positive change towards her health behaviour, become motivated to succeed and have perseverance once she has decided on a plan of action and she gain the ability to recover from setbacks, and the likelihood of maintaining the change over time (Dures and Hewlett, 2012, p.553)Joint Protection and energy conservation strategies through resting and using splinting, compressive gloves, assistive devices, and adaptive equipment have beneficial effects in managing RA symptoms and deformities, which help to stabilise Marjorys symptoms splints may be used to give desired position at rest and functional positioning to the involved active joints indirectly diminishing pain and inflammation, preventing development of deformities, preventing joint stress, supporting joints, and minify joint stiffness (Kanvucu and Evcik, 2004, p.4). Compression gloves give a gentle coalescency which is an advantage on controlling joint s welling leading to decrease of pain (Kanvucu and Evcik, 2004, p.4).Exercise therapy has physiological advantages of improving cardiovascular health, increasing tendinous hypertrophy and increasing bone mineral density also as a therapy, it enhances physical function and psychosocial advantages of the patients (Law et al, 2012, p. 332). Despite the positive reports about exercise, there are barriers to this management approach psychosocial aspects cause barriers, concerns relating to joint health and limitations in exercise prescription, musculoskeletal pain and fatigue (Law et al, 2012, p. 334).Pain Management strategies are needed because pain is the main cause for the lack of activity and losses of functional ability in RA patients, successful rehabilitation cannot be achieved if the patient is in pain, so the control of the disease with classic redress forms to control the pain and to improve the activities is needed (Giavasopoulos.E.K., 2008, p.65). Thermotherapies should be r ecommended for Marjory to use at home even if hot and cold stimuli, in inflammatory arthritis do not alter the articular inflammation, but improve the secondary suffice in the pain and the behaviour (Giavasopoulos.E.K. pg.66, 2008). Pain in the soles is common origination among RA patients, recommendations on using insoles from high density polypropylene, that are to provoke satisfactory treatment of the pain (Giavasopoulos.E.K., 2008, p.67). form rehabilitation strategies are needed Hammond (2004, p.143) points out key strategies to maintain people in work and these include rapid communication with employers, job modification, re-organizing work schedules short periods of rest should be allowed because rest decreases the inflammation and the pain and promotes the physiologic place of articulation. Good evidence indicates that introducing a simple work problem-screening tool assists early identification of work problems, and early work assessment reduces work problems, maintain p eople in work and results in high levels of satisfaction from workers with RA (Hammond, 2004, p.143).This assignment has justify the purpose of promoting the plans to transform care for patients with long term conditions, particularly RA for this case, by showing how the policy of improving quality of care for people with long term should be implemented in the healthcare system. The key principle priorities that were applied to Marjory, were provision of patient education, facilitation of self-management, delivery of patient-centred care, giving evidence-based interventions and improvising early proactive intervention these principles display patient involvement to improve the quality of care with the aim of producing good management outcomes and preventing secondary complications on the patient, so as toimprove the patients quality of life patronage her having rheumatoid arthritis.APPENDIX 1Proposed Management Approach Pro-formaStudent fig w12035846Scenario Number 1Current problem s identified in order of anteriorityPain, swelling and stiffness at the kneesStiffness in her hands MCP and scoot jointsSlight swelling at the hands lessen ROM rationalised grip strengthShort Term GoalsReduce painReduce swellingReduce stiffness outgrowth grip strengthIncrease range of motion in reference to the extension lack at the knees Increase muscle strength of quadricepsCounsel patient to clear emotional statusLong Term GoalsTo stabilize symptomsTo improve quality of lifeDoes the patient require any active treatment at the moment? If so, what? If not, why? Yes, in reference the swelling and stiffness around the hands Active treatments Paraffin wax therapy combined with hand exercises, chalk therapy for the knees, TENS, and Patient Education What strategies do you think it would be appropriate for you to use in assisting the patient to self-manage their condition at this stage? Joint resistance (energy conservation, assistive devices, splints) strategies, Pain management strategies heat therapyTherapeutic ExerciseWork rehabilitation strategiesHydrotherapyGait Training Evaluation and monitoring strategies using outcome measures How do you think your role will change / bourgeon in the long-term management of his patient?Physiotherapy plays as a role in rehabilitating Rheumatoid Arthritis (RA) with the goal to optimize function in patients. As a physiotherapist, role playing is recognised through providing patient education with reliable and appropriate information, and availing evidence based treatment programmes to the patient by identifying factors that will positively or negatively affect bread and butter of the management of RA condition. Also encourage the patient to have a positive mind set towards exercise prescriptions and physical activity tasks. Another role is to improve patients perception towards the management approach of RA.REFERENCESAustralia. The Department of Health and Ageing (2009) A picture of rheumatoid arthritis in Australia. Canberra Australian Institute of Health and Welfare (9) (pp.1,3,4) Online. purchasable at http//www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459857 (Accessed 14 may 2014) Canada. Ontario Medical Association (2009) Policy on Chronic Disease Management, Ontario Health Policy Department Online Available at https//www.oma.org/Resources/Documents/2009ChronicDiseaseManagement.pdf (Accessed 7 May 2014) Canada. Department of Health and Community Services (2011) Improving Health Together a policy framework for Chronic Disease Prevention and Management in Newfoundland Labrador. Newfoundland Labrador The Department of Health and Community Services. (p.7) Online Available at http//www.health.gov.nl.ca/health/chronicdisease/Improving_Health_Together.pdf (Accessed 14 May 2014) Demoulin, C and Vanderthommen, M. (2011) Cryotherapy in woebegone diseases, Joint Bone Spine, 79, pp. 117-118. ScienceDirect Online Available at (Accessed 20 May 2014) Dures, E. and Hewlett, S. (2012) Cognitivebeha vioural approaches to self-management in rheumatic disease, Perspectives, 8(10), p.553. Online Available at (Accessed 27 May 2014) Giavasopoulos, E.K. (2008) Rehabilitation in Patients with Rheumatoid Arthrits, Health Science Journal, 2 (2), pp.