Implementation of the WHO Strategy for Prevention and Control of Chronic Respiratory Diseases

HCS & chronic conditions: 4 problems – 4 solutions

Lack of communication.   
There are inherent problems in a system designed to recognise acute problems only. Many of the acute illnesses presenting at the level of first patient contact are actually an exacerbation of a chronic condition. The lack of communication of patient history from one visit to the next or from one level of care to another is a major gap in the continuity of care which can lead to misdiagnosis, inadequate care, and further progression of illness.

Alternative methods for follow-up and feedback need to be devised to ensure continuity.

Passive patients.
Patients are not encouraged to be active participants in their own long term care. CRDs often require daily self management, i.e. monitoring their condition, self medicating, and controlling for their environmental risks over a period of years if not a lifetime.

Patients must be educated about best practice regimens and prepared to act on their own behalf. Patient education and self-management advice given to those with asthma has been conclusively shown to reduce symptoms, use of hospital facilities and time off work or school. The benefits are greatest in those receiving written personal asthma action plans. They may work by enhancing compliance. Evidence of benefit from self-management education in those with COPD is less clear but this probably reflects the reduced efficacy of therapy for this condition. Lifestyle advice is still likely to be of importance.

Lack of integration.
Many of the management tools for CRD patients involve the services of people in the community, family members/home care provider, rehabilitation services, educators of young children, employers who enforce smoke free work zones, etc.

Synergistic linkages need to be created between health care systems and communities for patient well being.

Improper training.
Primary health care providers may be inadequately trained to recognize the multiple manifestations of chronic illness, which can result from common risks. Because NCDs commonly share risk factors, a patient who presents with symptoms may be suffering from both a CRD as well as another NCD such as cardiovascular which may have both developed as a result of smoking tobacco.

Providers must be prepared to address illness with integrated guidelines, appropriate diagnostic tools and correct treatment options.