Introduction
Diabetes mellitus is a chronic disease; this is in disregard to the type- whether type-I or type-II. As such, the disease needs long term care and management. Additionally, occurrence also puts such a patient at risk of developing other co-morbidities such as chronic wound, failure of peripheral nerves, retinal damage and poor healing of wounds with possible amputation.
While the original is easily manageable with the correct care, the patient has to be well informed about the disease and taking care of himself. However, in the presence of co-morbidities, the situations gets trickier since some of the conditions that arise can only be treated by a medical professional.
This offers a unique challenge in the management of diabetes and other chronic diseases; the fragmented healthcare system that is geared towards management of short-term medical emergencies often is not well prepared for the patient that has to move from one level of care to the next; for example for a diabetics patient moving from a general practitioner to a foot specialist. As such, crucial time and information is lost during this transit.
Health Promotion
This involves giving people more control over their health for the purposes of improving it. For an individual to be said to have achieved optimum health in terms of physical, mental and social, s/he must be able to fit and adapt into his/her environment such that his/her aspirations and desires are fulfilled. As such, health and wellness cannot be placed as the sole responsibility of professional medical practitioners and healthcare provision agencies; since the definition of health that encompasses the environment and lifestyle cannot be controlled or modified sufficiently by these parties. The World Health Organisation lists the requirements for optimum health as the following: peace, shelter, education, social security, social relations, food, income, empowerment of women, a stable eco system, sustainable resource use, social justice, respect for human rights and equity. WHO also acknowledges that poverty is the greatest threat to health.
A good model for health promotion is the Ottawa Charter; this has five strategies; creating supportive environments, developing personal skills, reorienting health service, building healthy public policy and strengthening community action. These can be applied for the sake of improving the health of our case study in regards to management of the diabetes mellitus.
Building public health policy
Health promotion should aim at developing the healthcare agencies to enable them serve their customers better; such would help the providers see how their decisions impact on the health status of the patient [Glasgow et al. 1999]. For example, the case study tells of how the patient Mr. Borg made a transition form his former physician to a much younger one; who he doesn’t consider to be competent enough. This may be due to the facts that his former GP was also form Malta; thus they had a better rapport; alternatively, this may be due to the fact that his new GP is much younger. Nevertheless, the communication between Borg and his physician is not sufficient.
Public policy should be built around a structure that would allow Frank to move smoothly from one physician to another (Daniel et al. 2004; Etzwiler 1997). Additionally, such policy would foresee and solve a situation whereby a patient such as Mr. Borg defaults on purchasing and/or taking medication after prescription; thus putting him directly in the path of developing co-morbidities triggered by diabetes.
Strengthening community action
Health promotion activities must take into consideration of the fact that the community plays an important part in determining the health of the general population; and that it should be significantly incorporated into any program aimed at improving the health of an individual and the population.
Such incorporation would involve supporting various endeavors initiated by community agencies; and equipping them with maximum information that would allow them to function sufficiently. Such communities will. In time acquire enough skills to cover at least part of the care gap left by the formal healthcare resources.
As part of the care to Mr. Borg, his current physician, Dr. Birch had given him contact details to the community based Diabetic Educator who would have taught him how to measure his blood glucose concentration and to self-administer insulin through injections. Although Frank never acquired this medication and never contacted the educator, such an encounter would have been beneficial to him. Frank would have stood to benefit not only from learning how to take better care of himself in managing his condition, but the educator would have found a way to cover some of the care-gap arising from the fact that Frank is a widower; and that his daughter live 80km away.
Such an agency would have helped him in some areas which he is lacking in; such as preparation of healthy meals at home. For a better outcome of the case, it is imperative that Frank makes contact with such an agency to as to reap maximum benefits.
Developing personal skills
In regards to management of diabetes, Mr. Borg has a lot to learn in terms of self-care. The patient will have to develop skills and practices that will enable him to live a healthy life in the future despite his current condition (Bastable 2007).
Among the most important issues that he has to handle is his diet; he should learn to eat more whole grain and less of foods with high fat content such as processed meat. Frank should also reduce the intake of takeaway food. Additionally, a reduction of his current intake of alcohol to just one glass of wine per day is recommended (Knowler et al. 2002; Lindström et al. 2006).
Frank has to learn to recognize signs that his condition is worsening; for better management of his condition, the healthcare agency has to provide maximum information about diabetes. Some of the complications such as poor healing of wounds and having optical complication are already beginning to set in. The most important thing for Frank to learn is when to seek medical help; as much as diabetes is a chronic disease requiring long term care with a lot of personal input, there are some instances that the individual cannot handle by himself. For example, he should not insist treating the wound on his leg with antiseptic wash since it is the underlying issue that is causing the wound not to heal.
Frank also has to learn what to change in his lifestyle so as to discard the potentially harmful ones. We already have mentioned the diet. Frank should reduce (or preferably quit) smoking. Additionally, since his work may involve the use of sharp tool, he should know of the potential of small wounds resulting in amputation of the foot; and should know to take extra care when dealing with these tools.
Most importantly, however, Frank should gain skills of taking care of himself; these include measuring of blood glucose concentration and injecting himself with insulin; and at the correct time. Equally important, the patient should learn to respect medical opinion; he should appreciate that he doesn’t have enough information to make decisions as ones he has made in the past, such us using medication; and should not infer other cases, such as that of his mate Chico, to himself since the circumstances are not similar.
Creating supportive environment
As much as Frank is suffering from a potentially debilitating condition, this should not mean that his life is over. He has a very vibrant and presumably satisfying life; decorated by a successful and fulfilling business, a circle of close friends (who he plays cards with), a loving extended family and voluntary work both at the State emergency service and at the local church.
As mentioned before, health promotion activities are not restricted to periods when an individual visits a healthcare facility. Health promotion involves ensuring that a person has an optimum social, environmental and even professional state. Every effort should be put to ensure that the disease does not rob Frank of any aspect of his life that he considers fulfilling; and that which defines who he is. Any such loss would have a definite negative effect for the prognosis of his general welfare.
Reorienting health services
For a long period, the healthcare system has been oriented at giving curative services for the various condition presented to them. This results in an obvious problem; the system has been reactive, waiting for something to go wrong so as to respond. In the case of a disease such as diabetes which has a high probability of developing serious co-morbidities, such would be left to develop before attention is paid to them. In short, the system is geared toward acute care.
Reorienting the healthcare system would involve changing the focus from acute care to a comprehensive model that would predict and prevent the occurrence of co-morbidities of diabetes (Norris & Olson, 2004). Such would not only save the patient a lot of trouble in terms of dealing with multiple disease, but it also would remove some of the burden that the healthcare system than co-morbid chronic diseases are causing.
Mr. Borg has already seen the initial stages of two co-morbidities; one is the wound on the leg that is showing the characteristic of poor healing. The other one is the retinal damage leading to blurred vision. Mr. Borg is planning to make an appointment with an optometrist for prescription of a pair of glasses; in a comprehensive chronic care system, such a problem would have predicted and prevented; instead of wasting time and resources going to a medical specialist who may not be adept enough to handle such a case caused by the underlying metabolic condition.
Conclusion
Proper management of diabetes in Frank Borg should involve more than just medical intervention. In order to promote health, such interventions should extend well and alter his lifestyle, perceptions and opinions.
A system that is aimed primarily at solving acute events would not be of proper service to him since these would only be reactive instead of proactive. Development of co-morbidities is one of the biggest threats to a diabetic; taking proactive steps to prevent this would go a long way in ensuring a proper life for Frank.
References
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- Etzwiler DD 1997, ‘Chronic care: a need in search of a system’, Diabetes Education, Sep; 23(5):569-73
- Glasgow RE, Wagner EH, Kaplan RM, Vinicor F, Smith L, Norman J 1999, ‘If diabetes is a public health problem, why not treat it as one? A population-based approach to chronic illness’, Annual Behavioral Medicine, 21(2):159-70.
- Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E, Nathan D 2002, ‘Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin’, New England Journal of Medicine 346 (6): 393–403.
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- Norris SL, Olson DE 2004, ‘Implementing evidence-based diabetes care in geriatric populations. The chronic care model’ Geriatrics 2004 Jun; 59(6):35-9.