Acute and Primary Health Care

Chronic Diseases

Chronic diseases are sicknesses of long duration that progress slowly. Various health conditions and illnesses can be categorized under the broad heading of chronic disease. The Chronic ailments are generally characterized by:

• various risk factors
• complex causality
• prolonged course of illness
• long latency periods
• Functional disability or impairment.

Many chronic ailments do not spontaneously resolve, and they are usually not cured wholly. There are several that can be directly life-threatening, for example stroke and heart attack. Others can persist for a while and can become severe in management terms (for instance diabetes). Many chronic illnesses persist in a person through life, but they do not usually cause death (for instance arthritis). For different reasons, including facts that more individuals are living to old age and the improvements in management and treatment, there has been an increase in chronic diseases prevalence in the past.

Chronic diseases like asthma, heart disease, and diabetes mellitus are the top causes of disability and death. They are caused by various reasons that include environment, lifestyle, and genetics and they are anticipated to be more frequent as people age and the risk factors increase. The burden caused by these situations can be high, not just for those individuals that have them, but for their families too.

Majoring on Diabetes;

Diabetes, frequently referred by doctors as diabetes mellitus, it explains various metabolic diseases wherein an individual has high blood (blood sugar) glucose, probably due to inadequate insulin production, or because of lack of proper response by the body’s cells to insulin, or both. A Patient having high blood sugar normally experiences frequent urination (polyuria) they may become ever more hungry (polyphagia) and thirsty (polydipsia).

3 Types of Diabetes

• Type 1 Diabetes

The immune system destroys the beta cells that make insulin in the pancreas, this cause severe, frequently total lack of insulin. This type of diabetes is common mostly during young adulthood and childhood but it can take place at any age. Individuals who have type 1 diabetes have to receive daily injections of insulin to sustain life, and they should do finger prick blood glucose tests regularly to check their diabetes. A progressive development in managing and introducing new technology has led to reduced complication rates and has greatly improved the life expectancy.

• Type 2 Diabetes

Individuals having this type of diabetes experience relative insulin deficiency and they are resistant to insulin action due to continuous failure of their pancreatic beta cells.

An inherited vulnerability to this type of diabetes is provoked by abdominal obesity. This Type of diabetes frequently occurs in the elderly and middle aged people, although it is becoming common in children, young adults and adolescents, mostly in the Aboriginal populations.

Diabetic complications and Type 2 diabetes are frequently asymptomatic, making it difficult for early diagnosis. In Aboriginal and other risky, under-resourced and remote groups, diabetes is usually undiagnosed till there is development of advanced complications. Around 90% of all diabetes cases in the world are of this type.

Some individuals can control their symptoms of type 2 Diabetes through weight loss, having a healthy diet, exercising, and observing their levels of blood glucose. Nevertheless, type 2 diabetes is usually a progressive sickness – it gets worse gradually – and the patient probably ends up having to take insulin, which is usually in the form of tablet.

Diabetic Complications

Constantly elevated levels of blood glucose in the two types of Diabetes lead to damaging of small blood vessels inside the kidney and retina. Elevated concentrations of blood glucose interact with the high blood pressure as well as the altered blood lipids causing accelerated atherosclerosis within arteries in the legs, brain and heart.

Overweight and obese individuals have a greater risk of getting type 2 Diabetes when compared to the people having body weight that is healthy. People having lots of visceral fat, also identified as belly fat, abdominal obesity, or central obesity are particularly at risk. Being obese/overweight makes the body to release chemicals that are capable of destabilizing the body’s metabolic and cardiovascular systems. Men having low levels of testosterone have higher risk of getting type 2 Diabetes.

• Type 3 Gestational Diabetes

This type usually affects the females during pregnancy. Various women have extremely high glucose levels in their blood; therefore their bodies are not capable of producing enough insulin for transporting all the glucose into their cells, this result in progressive rise in glucose levels. Gestational diabetes is generally asymptomatic, and it is detected through screening tests. Its Treatment consists of modification on diet and, in a number of cases, injection of insulin. Up to 50% of the women that have experienced gestational diabetes consequently get type 2 Diabetes. Gestational diabetes’ diagnosis is usually made during pregnancy. Most of the patients having gestational diabetes may control their diabetes through dieting and exercising.

What Is Pre-Diabetes?

Majority of patients having type 2 Diabetes at first had pre-Diabetes. The levels of their blood glucose were higher than the normal, but it was not high enough to merit a diagnosis of diabetes. The body cells then become resistant to insulin.

Diabetes mellitus is classified as a disorder of the metabolism. Metabolism is how bodies use the food that is digested for growth and energy. Most of what is eaten is broken down to glucose, a form of sugar inside the blood. Glucose is the main fuel source for our bodies. When food is digested, glucose goes to the bloodstream. The cells use glucose for growth and energy. Nevertheless, glucose cannot go into the cells without presence of insulin. Insulin enables the cells to take the glucose. Insulin is a hormone which is produced by pancreas.

A person having diabetes has a situation where the amount of blood glucose is extremely elevated (hyperglycemia) It is as a result of either the body not producing enough insulin, producing no insulin, or having cells that do not respond well to the insulin produced by the pancreas. This leads to building up of too much glucose inside the blood. Excess blood glucose is finally passed out of the body inside urine.

Burden of the Disease

Diabetes is a major cause of death within Australia and it is the fastest growing disease worldwide. Diabetes mellitus is among Western Australia (WA)’s most important issues of health. Every day, almost 30 individuals are diagnosed with diabetes in WA. Type 2 diabetes is the form that is most common; it comprises 85 to 90% of those that have diabetes. The occurrence of type 2 diabetes has been growing. International and WA data shows that occurrence of type 1 diabetes increases approximately at 3% yearly. Diabetes burden is unequally distributed across the society. Diabetes-related mortality in 2001-03 in nearly all disadvantaged parts of Australia was higher by 82% than the areas that were least disadvantaged.

Diabetes in the Aboriginal People

The commonness of diabetes is two or four times advanced amongst Aboriginal individuals than among the non-Aboriginal people. In various Aboriginal communities that are remote diabetes occurrence is as high as 30%. The Type 2 diabetes usually develops at the younger age, and it is linked to various risk factors for example abdominal obesity, hypertension and Dyslipidaemia. Others also have the renal disease. Diabetes is seen to be a major contributor of the excess Aboriginal people mortality whose life expectation compared to other Australians is 17 years less. In WA, diabetes death rates are 13 times higher when it comes to female and it is six times higher when it comes to the male Aboriginal citizens than for the non- Aboriginal citizens. Various studies have shown clearly that weight loss can delay or prevent Type 2 diabetes in the high-risk persons

Diabetes Complications

Diabetes is recognized to be:

• A major cause of the cardiovascular disease
• a very common reason for starting renal dialysis
• a common cause of the blindness amongst people who are under 60 years
• a very common cause of amputation of the non-traumatic lower-limb
• among the most common chronic sickness in children

Hospital Admissions

People who have diabetes stay longer in hospitals and the outcomes are poorer. In Western Australia, the diabetes related problems admission rate to hospitals for Aboriginal when dealing with age females is 17 times higher and it is 10 times higher for the Aboriginal males when compared with non-Aboriginal people

Diabetes Awareness, Early Diagnosis and Prevention Services

Type 2 diabetes together with its complications is very avoidable. People who have IFG/ IGT or a history of gestational diabetes can reduce the risk of getting type 2 Diabetes by possibly 60% by regular physical activity, eating healthy and moderate loss of weight. An environment that supports and promotes healthy lifestyle is very important in reducing diabetes risk in the society. Diabetes prevention and awareness services are offered by many individuals and organizations in the government, the non-government and the private sectors.

Long Term and Initial Managing of Type 2 Diabetes

A lot of patients having type 2 Diabetes are usually managed in the society by the general practitioners, through variable input from educators of diabetes and dieticians by referring the patient directly to particular practitioners, or to the multidisciplinary teams that operate in the government, the non-government and the private sectors within the larger group practices, the General Practice Divisions, different community services, teaching hospitals or general hospitals. A lot of patients are as well referred to ophthalmologists, podiatrists and optometrists while some to the public or private endocrinologists.

Self-management education on Diabetes, a cornerstone of the diabetes care, is offered by dieticians, registered nurses and additional health professionals who have undergone further training to be diabetes educators. Education on Diabetes is as well provided by the general practitioners, nurses, specialists, pharmacists, dieticians, websites and other different sources.

The Aboriginal people, persons living within the outer metropolitan, rural and regional parts and members of the other vulnerable and high risk groups continue suffering diabetic complications of high rates, and they are over-represented in the admission statistics of hospitals.

Lacking knowledge of the available resources and lack of coordination of the large organizations number as well as individuals to provide diabetes services pose as major barriers to the access and the optimal health results. There is a great need of developing well-organized interface amid community health and general practice services at local level.

Innovative strategies are required for overcoming challenges that are posed by the cultural factors, service gaps, language, remote locations and special needs of the Aboriginal people as well as other vulnerable and high risk groups who suffer from unduly high morbidity rates plus mortality from diabetes.

Early Detection and most Favorable Management of the Complications; Specialist Services

People having recognized diabetic complications require timely access to the right GP as well as specialist management services. Improved control of the blood pressure, glucose and lipids as well as Smoking cessation slows progression of the diabetic complications. Multidisciplinary high-risk and Professional podiatry foot services are very effective for avoiding amputations and ulceration. Laser photocoagulation is extremely effective when it comes to preventing loss of vision in people who have advanced diabetic retinopathy. Access to additional specialists is required for best management of the advanced complications.

In several cases, screening of complications is usually arranged by the general practitioners, in association with optometrists, podiatrists, ophthalmologists plus other specialists. Regular use of local protocols, recall systems, patient registers, service directories, guidelines and management plans that are patient-held is required for ascertaining that everyone with diabetes gets comprehensive, ongoing care.

Review of expert endocrine is required for people having poorly controlled diabetes those that need intensive therapies which include insulin, those having diabetic complications that are advanced and additional complex medical problems, along with patients having metabolic derangements that are severe plus the other acute problems. The majority of these patients ought to be referred to the general practitioner whenever particular problems are addressed and appropriate management plans are formulated.

Everyone who has Type 1 Diabetes and every child having diabetes is supposed to be referred to the specialist services for management that is long term. The services of Specialist multidisciplinary endocrinology are now provided inside private practice and in units that teach hospital diabetes. Accessing these services is limited by a long waiting list, shortage of workforce, distance, lacking specialized fast access services, and restrictive funding mechanisms. Other specialists playing important diabetes management roles include cardiologists, ophthalmologists, nephrologists, orthopedic and vascular surgeons and the bariatric surgeons.

Managing Acute Illness in Individuals that Have Diabetes

People who have diabetes ought to have an action plan with which they can manage a decline within their health status, this includes how and when to ask for professional advice. Appropriate telephone contact with a specialist nurse educator, general practitioner, nurse practitioner diabetes educator, or dialectologist/endocrinologist is often able to prevent progression to a serious sickness and hospital admission. Lacking or failing to use these options has led to increased reliance on the emergency units to accomplish this role, mainly in the outer metropolitan areas, that contribute to excess ED workload and bed pressures that are compounding.

Local systems are required in the general practice to guarantee rapid access to professional assistance and advice when required. Area responsibilities ought to be allocated to particular secondary and tertiary care centers and additional specialist services to make sure all the metropolitan, rural and regional providers of primary health care can easily access professional multi-disciplinary teams for shared care and advice.

Managing Diabetes in Hospital

Patients who have type 2 Diabetes are usually admitted directly to the diabetes units for the management of diabetic as well as additional emergencies in addition to management of the acute illness and complications that are advanced. Foot ulcers which are caused by vascular ailment and neuropathy are a common cause of the prolonged admission to hospital, which requires close liaison with microbiology, podiatry, vascular surgery, orthopedic surgery, imaging as well as home care services.

Various patients get admitted to the general hospitals for diabetes stabilization. Such admissions are generally ineffective and unnecessary. Type 2 Diabetes which is poorly controlled is best managed in a setting of ambulatory care by an experienced multidisciplinary team. Professional services for those adults that have type 1 diabetes are offered by teaching the hospital outpatient clinics as well as the endocrinologists inside private practice.

Understanding Primary Health Care Model;

Primary health care is a model of community-based health service delivery. Its operation is through a broad range of services for example community, youth and women’s health service. Primary health service model of healthcare and philosophy was documented and articulated during the first worldwide conference in 1978 that involved primary health care. Primary health care system is necessarily part of the publicly funded health system, provided at no cost to those who access the service, and is not regarded as for profit model of service delivery.

Primary health care is about the work done by health care experts who act as where consultation should first be made by every patient that is in that health care method. Examples of those professionals are often the primary care physician, for instance a family physician or general practitioner, non-physician provider of primary care, for example a nurse practitioner or physician assistant. Depending on the area, the system of health organization, and at times at the discretion of the patient, one can first see a different health care expert Depending on the condition of the health; patients can later be referred for acute care. Primary care is engrossed in the broadest extent of health care, it includes patients of all ages, geographic and socioeconomic origins, patients who seek maintaining their most favorable physical condition, and patients who have every manner of chronic and acute physical, social and mental health matters, including many chronic ailments.

When discussing this model in relation to diabetes problems, we draw different conclusions. This model has its advantages and disadvantages. It majorly involves consultations. In this model, patients of all manners are welcome. Diabetes patients can be given a lime light on how to handle their problems.  This model helps a lot in that you can access your physician easily. A person can be given information easily as it is possible to deal with a family doctor. This model has its disadvantages too. An individual is usually referred to secondary treatment when situation needs severe attention.

Acute care involves health services which are offered in an institution of tertiary care, for instance a hospital. Here, a patient is given temporary cure which is active but it is usually for patients with serious injuries, sickness that is for a period of time, a medical situation that is urgent, or those patients that undergo surgery.

Generally, health care professionals from various surgical and medical expertises deliver acute care service. Acute care might necessitate that one stays in the emergency department of a hospital or in whichever other temporary stay facility. When patients are deemed stable and healthy, the acute inpatient care which is hospital based is responsible for discharging them. The setting of acute care includes though it is not limited to; intensive care, neonatal intensive care, cardiology, coronary care and several common areas in which patients might become acutely ill and need to be stabilized and transferred to a different unit of higher dependency for additional treatment.

The advantage of this model is that a patient who is at the point of death can be attended to immediately. Patients are given temporary treatment and this may help the diabetic patient. Another advantage of this model is that the patient stays in emergency department where they are attended to. A disadvantage of this model is that treatment is temporary although it is active. Also the treatment conducted here is usually for the individuals who have severe injuries, long-time sicknesses or an urgent medical state. The diabetic patients who are not very seriously ill are often not attended to in a fast manner.

Therapeutic relationship is basically the relationship that involves somebody who acts in the helping role, and that person being helped. Whilst the sector of primary health care delivers services which meet requirements of most citizens requiring treatment for long period of sick-health, it is not as successful when dealing with the requirements of people who have conditions that are more complex. Primary care practitioners should have broad width of information in numerous areas. stability is a major primary care characteristic, because patients frequently prefer consulting a certain practitioner for preventive care and routine check-ups, education about health, and each moment they need a first consultation on health problem that are new.  In medical terms, care for acute health conditions is the opposite from chronic care, or longer term care.

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