Editorial
Innovation in chronic illness management: Will nurses contribute?
Sally Wellard
Associate Professor, Director of Partnerships,
School of Nursing, Deakin University, Melbourne VIC
PP: 005 - 006
Article Text
Although there have always been chronic illnesses in human societies, the prevalence and impact have grown dramatically over the past century. In the past long term illness was less visible in a world where death from infectious diseases was more dramatically visible.
The past few decades of increasing sophistication of medical technological intervention has seen improved life expectancy and we have seen the consequent increased visibility of chronic disease. Western affluent societies have increasingly aging populations, who by virtue of their age have an increased incidence of chronic illness and disability.
A chronic illness for this discussion refers to a condition that lasts over a long period of time, limits activity, and may require ongoing care. People with different chronic conditions face common problems - economic, social, and psychological. The experience of having a chronic illness leads to significant impact on the quality of life of both the individual and their families.
Five of the six national health priority areas for Australia reflect the serious extent of the impact of chronic illness on health in this country and are: Cardiovascular disease; Cancers; Mental health; Diabetes, and Asthma. The sixth area of injury prevention and control is also related to the high degree of long-term illness and disability resulting from accidents.
This is not new information to health care professionals - but we have seen little change in a health care system that continues to invest substantially in acute episodic care. We have made little progress in developing integrated systems of health care support for providing effective management of chronic illnesses in Australia. Indeed the incidence of chronic illness amongst indigenous Australians remains unacceptable with significantly shorter life expectancy and increased experience of chronic illness compared to other sectors of the Australian population.
The National Health and Medical Research Council (NHMRC) of Australia has recently announced investment in research for developing improved systems of care for chronic illnesses ( www.nhmrc.gov.au/research ). Specific funding will be targeted to develop the national capacity for planning and providing improved prevention and intervention strategies related to chronic disease.
The six identified areas where knowledge is under-developed are:
- Consumer participation, social capital and social support;
- Access - Geographical, socio-economic and cultural;
- Economics of Health;
- Continuum of care, new models of care;
- Evidence based treatment and care; and
- Health and life course
The NHMRC have suggested a need for a change in approach and a greater involvement of other disciplines (for example, social scientists) in conceiving new systems for chronic illness management. This raises the question of how and where nurses can contribute to the new strategic developments.
Nurses have considerable experience in the care and support of people with chronic illness, both in institutional and community settings. The new initiatives of the NHMRC offer nurses' opportunities to share their wisdom about systems that can work and those that are less effective. For example, nurses have taken considerable initiative in designing and refining clinical pathways, case management and hospital in the home programs of care. We can take the next step and use this knowledge to inform the development of new and better systems of care.
In the past, nurse researchers have had little success in gaining funding from NHMRC to support their work. These new strategic funding initiatives will arguably remain difficult for nurses to access. Therefore, we need to build multidisciplinary research teams and continue to lobby government to review the distribution of money to ensure there is broad representation of interests in chronic illness management.
Given the complexity of designing alternative systems of care, it is important that we continue to develop innovation at the practice level. Nurses need to reflect on the six areas identified by the NHMRC and how their current practices are related. For example, to what extent do current practices foster direct consumer participation in care? How does current nursing care delivery ensure continuity of care across sectors? How do we evaluate the effectiveness of the nursing interventions we use in the care of people with specific chronic illnesses?
It will be important for the nursing profession to take up the challenge of actively contributing to the development of improved management systems for chronic illness. During a time of nursing shortage, redesigning health care systems could result in redesign of the health workforce. We need to maintain a strong voice to demonstrate the critical influence of nursing in improving outcomes for people with chronic illness.
I invite you, the reader, to carefully consider these initiatives and to begin to consider how to ensure that nurses actively take roles in these new initiatives to tackle chronic illness. I am confident we can influence the future of chronic illness management, but we will only do so by working together.
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