• Subject Name : Nursing

Multi-Morbidity as A Barrier to Self-Management

Question 1:Multimorbidity is the condition in which two or more diseases at the same time develop in a person. This is highly prevalent in the aging population where the old age people are suffered from multiple chronic diseases. The outcomes for the health of these patients are worst and they have a high risk of medication issues and regular physician visits. Along with the concept of multimorbidity, it is seen that there is a lack of energy in anemic patients because the person also develops depressive symptoms in which the individual lives with undesirable emotional and physical symptoms such as fatigue and chronic pain. These factors then contribute to the loss of energy in anemic patients. Though Diabetes is not said that it directly causes anemia but some certain conditional associations and complications contribute to it. The person in this concern is advised to take lots of medications and has frequent doctor visits. Thus, people with diabetes also have anemia because of not eating well and having interference min absorption of nutrients (Knowles, Chew-Graham, andAdeyemi et al. 2015). They result in a loss of energy. From the biological perspective, multimorbidity contributes to a lack of financial resources, the effect of the cognitive approaches, and the complexity of social support. Patients generally have limitations to deal with their emotional and physical symptoms. Social support id the major barrier observed in multimorbidity as self- management at the times when friends or family interfere with the treatment plans or interdependence. The financial constraint rises due to lack of insurance services with patients and there is lots of financial strain on expensive medications. The frequent consultations with physicians might also result in a reduction in employment production time or too short- or long-term unemployment (McPhail, 2016).

Question 2:In the conditions of multimorbidity, self-management and patient-focused approach are the risk factors that contribute to challenges to organizational care. Through self-management, the patient finds out the ways to manage their medical complications. The range of behavior has been seen in the patients that they manage their problems including self-modification home-care regimes, adherence to medication, dietary recommendations, and early identification of deterioration. Although then also there is some mismatch found between the desires of the patient and what they receive. These factors contribute to understanding the needs of patients as well as managing the organizational structure to experience care coordination. This is the concept that conceptualizes the organizational problems into integrated healthcare systems. This is because the patients suffering from multimorbidity gets affected by the problems of care coordination in healthcare service delivery. The point here that arises is the experience towards the perspective of the patient. Evidence-based healthcare is in general the basic need to deal with the patients suffering from multiple complications. Moreover, the experiences of the patient in the health system related to the accumulated burden, accessibility, professional-to-professional communication, and organizational care. These all factors contribute to discontinuity in processes, insufficient facilities, insufficient time allocated, and understaffing. The professional to professional communication is referred to patients experiencing discontinuity of information (Struckmann, Leijten, andGinneken et al., 2018).

Question 3:Though health literacy is very important in self-care management to overcome the disease pattern at different levels. Medical care that is provided by healthcare professionals in modern times is being highly specialized. The patients are mostly treated in tertiary healthcare institutions where the concern of their health as well as various circumstances is taken care of. At the same time, the patient demands contact with the consultant to get an early appointment with the doctor. To deal with this, self-care management plans as well as several interventions contribute to the improvement of people with multimorbidity. ‘Models of care’ could be the one intervention that could be followed so that we could get help with holistic assessment programs. This will include medication management, the patient held records, integrated care, providing continuity, multi-professional working, case management, care plan, improvement in continuity of information, and combination of all. This will affect the critical factors such as functional outcomes, health-related quality of life, admission to a care facility, career, and patient satisfaction, and health-related quality of life. Multidisciplinary care is the component in which the range of professionals gets involved in delivering comprehensive care to address patient needs at the time of requirement. The team comprises the members that deal with the patient's psychological as well as the clinical needs of the person. The holistic assessment is also one in which the trained healthcare professional is involved in a comprehensive assessment of a person's social, mental, and physical health condition. Individualized plans are made to provide subsequent care through different channels. Telephone follow is a method that provides telephonic support to patients in the context of medical care. In addition to this, home follow-up is another way of interacting with patients with pre-arranged visits of a healthcare professional (Boehmer, Abu, andGionfriddo et al., 2018).

Question 4:Due to the increasing demand for healthcare in the system, healthcare service delivery is associated with providing appropriate care and improving healthcare quality as the main issue. Various barriers are affecting the service of healthcare delivery such as acceptability, adaptability, availability, and accessibility in countries like Australia (Hyland, Raymond, and Chong, 2018). This is the reason because people are facing problems such as technological barriers, financial barriers, and social barriers in the development of telemedicine. Technology is the barrier in developing countries like Australia because of the high cost and the constant shift of replacing with older technology. The financial system of Australia is not supportive to bear the regular technological and financial burden. Although, it is said that telemedicine increases the access to care and reduce costs,but it is not true because lots of financial investments are needed to set up the system. The equipment, technology, andtrained professionals are needed to run a system. The social barrier towards telemedicine is there because of adaptation, sustaining, and utilization of services. The lack of ICT literacy, cultural gaps, language barriers is observed in Australia.

References for Self-Management Care Thesis

Boehmer, K.R., Abu Dabrh, A.M., Gionfriddo, M.R., Erwin, P. and Montori, V.M., 2018. Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis. PLoS One, Vol. 13 no. 2, p.e0190852.https://doi.org/10.1371/journal.pone.0190852

Hyland, P., Raymond, E.G. and Chong, E., 2018. A direct‐to‐patient telemedicine abortion service in Australia: Retrospective analysis of the first 18 months. Australian and New Zealand Journal of Obstetrics and Gynaecology, Vol. 58 no. 3, pp.335-340.https://doi.org/10.1111/ajo.12800

Knowles, S.E., Chew-Graham, C., Adeyemi, I., Coupe, N. and Coventry, P.A., 2015. Managing depression in people with multimorbidity: a qualitative evaluation of an integrated collaborative care model. BMC Family Practice, Vol. 16 no. 1, p.32.https://link.springer.com/article/10.1186/s12875-015-0246-5

McPhail, S.M., 2016. Multimorbidity in chronic disease: impact on health care resources and costs. Risk management and healthcare policy, Vol. 9, p.143.https://dx.doi.org/10.2147%2FRMHP.S97248

Struckmann, V., Leijten, F.R., van Ginneken, E., Kraus, M., Reiss, M., Spranger, A., Boland, M.R., Czypionka, T., Busse, R. and Rutten-van Mölken, M., 2018. Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review. Health Policy, Vol. 122, no.1, pp.23-35.https://doi.org/10.1016/S0140-6736(18)31308-4

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