News :Nurses to Play Leading Role in New Methods of Chronic Disease Treatment
Posted on Wednesday, April 29, 2009
Over the next two decades, 78 million “Baby Boomers” will nearly double the over 65 population in the United States. Three out of every five Boomers will struggle with more than one chronic condition – obesity, diabetes, arthritis, hypertension, high cholesterol, heart disease, AIDS or cancer – according to the May 2007 report, When I’m 64: How Boomers Will Change Health Care, compiled by the American Hospital Association (AHA) with First Consulting Group of Long Beach, California.
The sheer volume of aging Americans born between 1946 and 1964, in combination with steadily increasing longevity, is already beginning to change the face of U.S. healthcare. The rising incidence and cost of chronic disease has spurred increased emphasis on wellness and prevention programs and prompted innovative plans for providing healthcare services. As healthcare services move from traditional hospital/Physician office environments to home, community and Internet settings, nurses are expected to take a leadership role.
By 2030, 20 percent of the U.S. population will be over the age of 65, compared to 13 percent today. With life expectancy continuing to rise – in the last century it has increased from age 47 to 77 – chronic disease will remain a critical healthcare challenge. According to the AHA report, 62 percent of Americans aged 50 to 64 and 80 percent of those over 65 already struggle with at least one chronic condition that requires managed medical care. By 2030, the AHA expects 35 million – six in every 10 – seniors to be managing more than one chronic disease.
“The overall incidence of chronic conditions like diabetes and hypertension is growing, and will continue to increase as future generations reach 65,” note When I’m 64 report authors, adding, “Since the biggest factors influencing medical spending are chronic illness and a patient’s level of disability, the growing incidence of multiple chronic conditions will put increasing demands on our health care system.”
The cost of chronic illness in America is staggering. “On average, the cost of health care for an individual with more than five chronic conditions is nearly 15 times that of an individual with no chronic conditions,” according to the AHA report. Employers burdened with paying the bulk of workers’ medical costs are initiating wellness and prevention programs to combat chronic illnesses and rein in medical expenses. Prompted by employer incentive programs and increased public awareness of chronic disease risks, participation in wellness programs has risen from 10 percent to 15 percent when they were first introduced to more than 70 percent, said Joe San Filippo, Chief Healthcare Strategist for Nationwide Better Health, in a January 12, 2009 interview with Columbus (OH) Dispatch reporter Suzanne Hoholik.
Several prominent areas that offer significant promise for future chronic disease treatment are already being explored, including:
Community Wellness/Prevention Programs. Expanding hospital and corporate wellness and prevention programs into the community, and integrating those programs with existing community resources, is expected to play a significant role in the future management of chronic diseases. Providing preventive screenings and immunizations needed by America’s growing geriatric population in community settings that offer other senior services and/or recreation is seen as an important way to increase coverage, build personal relationships that encourage participation, and make more efficient use of nurses and Physicians.
Healthcare teams led by nurses or nurse practitioners could take a leadership role in such community initiatives as well. In one effort reported in the AMA When I’m 64 report, Reston Hospital Center in Reston, Virginia reported success with a community-based program to combat obesity. Through a community Web site hosted by the hospital, the 25-week program connected residents with local fitness and nutrition programs, events, classes and wellness screenings.
Some proactive communities are tackling such problems before they arise. Since 1977, non-profit Partners for Livable Communities has been helping communities plan for the future needs of aging residents through its Aging in Place initiative. Through the integration of housing, economic, transportation, cultural, and health care resources during development, their goal is to create communities that will remain viable and responsive to the changing needs of residents through every phase of life.
Patient-Centered Health Care. Higher patient education levels and the easy availability of medical data on the Internet are two factors driving the move to patient-centered healthcare. More informed patients and their families are demanding to be equal partners in heath care decisions and the provision of self care.
“Engagement of patients and families empowers patients to participate in care decisions, provide self-care, and protect themselves from potential harm,” according to The Joint Commission’s 2007 report, Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future.
In a case study reported by The Commonwealth Fund, a hospital in Michigan designed a patient/family-centered program for its maternal/child health area that earned a 95 percent patient-satisfaction rating. RN turnover/vacancy rates also improved, dropping to less than half the national average. Vital to the program’s success were nurses’ efforts to communicate and build relationships with patients and their families.
Remote-Accessible Technology. Technological advances that facilitate the computerized identification and tracking of patients with chronic illness are expected to improve follow-up care. Systems that actively monitor patients and allow for remote consultation with nurses may help alleviate recurrent hospital admissions of chronic disease patients. It may also be possible to partner remote-access technology with Aging in Place initiatives to help seniors better manage chronic conditions and maintain independence. The U.S. Veterans’ Affairs (VA) Care Coordination Home Telehealth Program already makes use of the VA’s extensive electronic health record system to provide remotely-delivered home care to 33,883 veterans, according to The Joint Commission report.
As the majority of America’s population enters their senior years over the next two decades, traditional hospital/Physician office settings will be unable to cope with rising demand, forcing treatment of chronic illnesses into new avenues. Programs that combine patient participation with community outreach and remote-access technology are expected to be at the forefront of America’s battle against chronic diseases. To be effective, these programs will need to be implemented, directed and monitored by highly-trained medical personnel. However, success within non-traditional community settings will also require a more holistic, empathic and social approach to patient care to which nursing skills are particularly well suited. New treatment approaches for chronic illnesses are expected to offer nurses opportunities to expand their managerial range and medical contribution.
The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.