Topic 1.2 Chronic Care Contexts

People with chronic conditions need to manage their condition long term, sometime even for the rest of their lives. Therefore, people with chronic conditions may access health care in a variety of settings, including primary, secondary and tertiary health care.

Generally, primary health care is provided by General practitioners (GPs), nurses, midwives, pharmacists, dentists, Aboriginal health services and allied health professionals may provide primary care services (AIHW, 2023b). The Australian Government Medicare scheme subsidises many primary care services (Department of Health, 2019) and according to their data for 2021-2022, there were 189 million GP consultations; 25 million allied health consultation; 4.1 million nurse, midwife and Aboriginal health worker consultations (AIHW, 2023b).

Secondary health care is usually provided by a medical specialist that is not the first point of contact such as a specialist doctor, a psychiatrist, physiotherapist or other allied health professional (Queensland Health, 2019a). It may be provided in a hospital, clinic or in the community (Queensland Health, 2019a).

Tertiary health care is highly specialist care, mostly provided in hospitals inpatient care and may include complex medical or surgical procedures. The patient may access tertiary care on referral from primary or secondary health professional or through an emergency department (Queensland Health, 2019a).

The Australian Government (2019) has produced an infographic which describes the health landscape within Australia (see image below).  The infographic has four tiers and incorporates the three levels of health care just described.

Determinants of health and other demographic factors

The first and largest tier is 'determinants of health and other demographic factors'. This includes education, employment, income, family and community, rural and remote and Indigenous Australians.

Health promotion and disease prevention

The second tier is 'health promotion and disease prevention'. This includes immunisation, food, physical activity, illicit drug use, tobacco control, alcohol consumption, mental health and cancer screening.

Primary health and community care

The third tier is 'primary health and community care'. This includes dental practice, pharmacy, allied health, general practice, primary health networks, community care and aged care.

Specialist, acute and residential care

The fourth and smallest tier is 'specialist, acute and residential care'. This includes specialist services (including outpatient), diagnostic and pathology, local hospital networks, residential care and secondary and tertiary hospitals (public and private).

People with chronic conditions are major uses of primary health care, and to a lesser degree, secondary health care.  A recent report on health care experiences in the previous 12 months indicates people with long-term health conditions such as chronic conditions were more likely to use all health services as follows:

• approximately 94.5% of people had seen a general practitioner (GP) at least once

• about 54% of people had seen a medical specialist

• about 20% visited a hospital emergency department (Australian Bureau of Statistics [ABS], 2022).

People seeking referrals to secondary health care report they often have to wait for services (ABS, 2022; AIHW, 2020B).  Those living in locations of most socio-economic disadvantage (26%) were more likely to report waiting longer for a medical specialist appointment than those living in locations of least disadvantage (19%) (ABS, 2022).

People with chronic health conditions reported:

• 4% saw three or more health professionals;

• 71% received coordination of care; and

• 17% reported a lack of communicated between health professionals, which caused issues (ABS, 2022).

People who received coordination of care had less issues related to poor coordination of care (ABS, 2022).

Whilst on professional experience placement, talk to your people you are caring for and listen to their views of care coordination. Reflect on whether they are involved in shared decision making about their care, as this, along with personalised care plans, is known to be effective for improving health outcomes for those experiencing chronic conditions (Poitras et al., 2018).

As you are already aware, the Aged Care Quality and Safety Commission (ACQSC, 2019) has developed the Aged Care Quality Standards. Organisations that provide aged care services are expected to implement and maintain compliance with the eight (8) quality standards of care. You will see that these standards also have consumer outcomes. These consumer outcomes are very relevant when caring for people with chronic conditions, many of whom will be elderly.

Reasons people seek care for chronic conditions  

Individuals access care for both prevention and management of chronic conditions (Randall et al., 2022). People seeking care to prevent the development of chronic conditions may need assistance with:

• Quitting smoking;

• Getting enough physical activity;

• Reducing alcohol intake;

• Eating well;

• Maintaining healthy body weight;

• Maintaining healthy blood pressure; and

• Having good cholesterol levels;

(AIHW, 2020c).

They may also wish to participate in population-based health screening for conditions like cancer through the following programs:

• BreastScreen Australia Program;

• National Cervical Screening Program;

• National Bowel Cancer Screening Program; and

• National Indigenous Bowel Screening Pilot.

(AIHW, 2020c).

Individuals with chronic conditions seek care to help manage their condition.  Chronic conditions are complex and require long-term management (Johnson & Chang, 2022). The level of care required depends on individual circumstances may vary from immediately life-threatening such as heart disease and stroke, while others require less intensive management, such as arthritis.

FROM THE VIDEO:

Silent chronic conditions and some lifestyle changes are pretty obvious ways people can reduce the risk of chronic disease. First of all, what is a heart health check and how can I get one? Heart health checks are assessments you can receive from your general practitioner (GP) to evaluate your risk of heart attack or stroke. Every four minutes, someone in Australia experiences a heart attack or stroke, highlighting the importance of being aware of our individual risks and taking steps to reduce them.

Heart health checks are covered by Medicare, making them free at bulk billing clinics for the general population aged 45 and over, and for Aboriginal and Torres Strait Islander people aged 30 and over. It's advisable to discuss with your GP, primary care nurse, or Aboriginal health practitioner whether a heart health check is suitable for you. These checks are recommended annually and typically involve tests for blood pressure, cholesterol, and blood sugar levels. This helps your GP assess your overall risk of heart-related conditions and provide tailored advice on necessary actions, whether it's medication, dietary adjustments, or maintaining current health practices. Health advice varies from person to person, so consulting your primary care provider is essential.

Another important check is for kidney health and other silent chronic conditions. Kidneys play a vital role in filtering blood and are impacted by overall health, blood pressure, and diet. People often aren't aware that their kidney function may be impaired until it becomes severe. If you have risk factors such as high blood pressure, age, smoking, or a family history of kidney disease, it's recommended to discuss with your GP, nurse, or health practitioner about getting a kidney health check. This typically involves blood tests, urine tests, and measuring blood pressure to assess renal function. Based on these tests, your healthcare provider can offer advice on reducing your risk of kidney disease progression or confirm that your kidneys are healthy.

In terms of lifestyle changes to reduce the risk of heart disease, kidney disease, and other conditions, quitting smoking remains crucial as it significantly contributes to these health issues. There are numerous ways to support quitting, including resources like Quitline (13 QUIT) and medical support through your GP, which is also covered by Medicare. Simply having a conversation with your healthcare provider can provide guidance on managing and improving your health.

These steps can effectively lower the risk of chronic diseases and promote overall health and wellbeing.