Topic 1.1

What is chronic care?

The term chronic condition includes a wide range of chronic and complex health conditions across the spectrum of illness, and often develop gradually, persist for long periods of time and cause more permanent tissue damage (VanMeter & Hubert, 2023). The features of a chronic condition include:

• Developing over long period of time;

• Usually a gradual onset (but can occur suddenly);

• Prolonged course of illness which may contribute to other health complications;

• Compromise quality of life and may have associated functional impairment or disability;

• Not usually life threatening but may cause premature death; and

• Complex and multiple causes.

It is important to develop an understanding of terminology relating to chronic conditions. The terms chronic condition, chronic disease, non-communicable diseases (NCDs) and chronic illness are frequently used interchangeably, but these concepts differ slightly (Johnson & Chang, 2022).

Chronic conditions are health conditions or diseases that are long-term in nature and are related to a combination of environmental, genetic, physiological, and behavioural factors (World Health Organization [WHO], 2022). Whereas chronic illness is often used to describe the human experience of the disease from the perspective of the person with the chronic condition (Johnson & Chang, 2022). This reflects how the condition is perceived and responded to from a holistic perspective (Johnson & Chang, 2022).

Co-morbidity is a term used to describe when a person has two chronic conditions at the same time (Johnson & Chang, 2022). Many chronic conditions share risk factors and therefore there is often a relationship between the original chronic conditions and the second condition that develops. Around 20% of Australians have at least two chronic conditions (AIHW, 2022c). When a person has more than three chronic conditions, this is known as multimorbidity (AIHW, 2022c).

isk factors are factors that impact negatively on health (Johnson & Chang, 2022). They may be categorised into behavioural, medical, genetic, demographic, environmental, social risk factors (Johnson & Chang, 2022). More simply, they can be categorised into modifiable and non-modifiable risk factors.

Modifiable risk factors for chronic conditions may include poor nutrition, physical inactivity, smoking, high levels of alcohol consumption and drug use, high blood pressure, high blood lipids, obesity and impaired fasting glucose (AIHW, 2020a; Johnson & Chang, 2022). You may have noticed that many risk factors are related. For example, an unhealthy diet may lead to obesity, raised glucose levels and raised blood lipid levels or a lack of physical activity may lead to obesity, increased blood lipid levels and increased blood pressure (Johnson & Chang, 2022). Non-modifiable risk factors may include age and heredity (Johnson & Chang, 2022).

Some people with chronic conditions are more likely to develop disabilities as a result of their condition. These disabilities depend on the underlying chronic condition and impact individuals in different ways. Similarly, people with a disability are more likely to develop a chronic condition. For this module, we will focus on the chronic condition component, rather than the disability component of care.

Chronic conditions are reported to cause the greatest health problems in the world (Wilson & Levett-Jones, 2020). It is important to develop a broad understanding about chronic conditions in the context of social determinants of health and burden of disease.