Health System.Com: Chronic Disease Management in PHC

It's been a long time since I wrote my last blog. I guess the reason is that I use “I am tired” as an excuse for being lazy and having no drive to study. Lately we all have been very busy with the packed schedule. We finished our class around 5 pm almost every day. Today, after preparing for my week 4 tutorial, I decided to put up a blog post regarding what I have read for the scenario. Dr Jati, as the recent graduated medical doctor in the scenario, has faced some problem in managing a diabetic patient during his first day working at the primary health Care Centre (PHC). The keywords of this scenario would be primary health care, team work, and chronic disease management.

First of all, primary health care (PHC) defines community-based health services that are usually the first point of contact that patients make with the health services. As we know, the health care workers who work as a team in PHC comprise of multi- professional background. They are general practitioners, nurses, pharmacists, midwives, administrative officers and so on. In terms of professional team, each health care worker is responsible for different tasks. They have the obligations to cooperate with other health care team members in delivering health services. None of them shall do an overlapping job or duplication one to another. Whereas, each of health care team has their own professional standard, own professional culture and own professional mechanism.

'multi- professional background in Puskesmas'

There's often blurring of lines among one professional roles and responsibilities working in a team. Task shifting in the health care settings might happen as a response to health workers shortage. For instances, if there are many patients waiting and doctors couldn’t handle them all, experienced nurses would be allowed to prescribe medications. Hence, teamwork, also known as collaborative approach ought to be carried out to tackle the above problem. Effective collaboration involves rational distribution of tasks among health workforce teams. Everyone would understand their specific roles and work for one common goal and orientation. This is just one of the examples where team work would make more efficient use of the available human resources for health.

In the scenario, the patient suffered from diabetes (an increasingly prevalent chronic disease) come for a visit to the PHC. So, why primary care? A.A Rothman and Edward HW (2003) have suggested a few reasons. First, most patients with chronic disease has less severe condition. Moreover, these patients often need a limited number of widely used and relatively nontoxic medications. Therefore, PHC can readily meet their clinical needs. Third, primary caregivers usually have more general training and clinical experience. This would be an advantage for the patients as most of them have more than one chronic condition. Forth, primary caregivers, especially recent graduates undergo more training in educating patients about behavioural change and self-management support. This is a key to comprehensive chronic disease management.

Nowadays, more and more patients with chronic disease seek health care in PHC, there must be some system changes which PHC could adapt to support more effective chronic illness care. A Cochrane Collaboration review (2001) concluded that four areas where interventions implemented to improve diabetes performance in PHC have reached a success. First, activities directed at changing health workers’ behaviour. For example, clear guidelines and sufficient expertise would help the doctors making clinical decision. Second, changes to the organization of practice. Strong leadership, appropriate incentives and effective improvement strategies are important to maintain a health care organization. Third, information system is enhanced so that patients’ knowledge, skills in handling chronic illness would be improved. Last but not least, educational and supportive programmes are targeted at the patients to achieve an effective self-management support.